Methods:
Urologists were randomly emailed 1 of 2 surveys including 6 vignettes of various patients with renal masses. Both surveys were identical other than the vignette patient gender (VPG) which was male in 50% and female in 50%. Self-selected respondents chose the single best treatment option from the following choices:
- Active surveillance (AS)
- Percutaneous or laparoscopic ablation (ABL)
- Partial nephrectomy (PN)
- Radical nephrectomy (RN)
Results:
Of the 423 urologists who completed the survey there was an even response to both surveys (210 vs. 213). Most respondents were male (93%), married (89%) and in private practice (44%). Age and time practicing were evenly distributed and the median number of nephrectomies done per year was 15. There were no significant differences in demographics between the respondents of the 2 surveys. When comparing AS, ABL, PN, and RN the only vignette that differed based on VPG was question 3 (p = 0.019). Comparison of any NSS vs. RN in question 3 (regarding a healthy 80 yo man/female with good exercise tolerance and normal kidney function, and a 5 cm exophytic lesion) showed male VPG was 1.67 times more likely to be recommended RN (p = 0.019). Urologist gender had no effect on these findings.
Conclusions:
In this survey study of practicing urologists the authors found that male patient gender increased recommendations for radical surgery and less nephron sparing strategies in a hypothetical older patient with a localized renal mass. The authors concluded that provider biases do not appear to be solely responsible for gender disparities seen in the treatment of a localized renal mass.
Presented by: Ankur Shah, Albany Medical Center, USA
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan, at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA