The MUSIC initiative, a unique regional quality improvement collaborative, is an effective way to analyze the patterns of care that are in place across multiple practices. It assesses practice patterns across multiple practice types across Michigan to provide a better cross-section of urologic practice. For the kidney project, 8 Michigan practices were analyzed from September 2017 onward. Due to the relatively recent initiation of the study, all patients were entered into the system at 120 days (4 months), so follow-up was the same across the board.
In the first seven months, 316 patients with newly diagnosed renal masses ≤7cm (cT1) were evaluated at the eight sites. Seven diverse pilot practices contributed data from visits to 16 physicians.
Of these patients, 139 (44%) initially chose definitive treatment and 123 (39%) pursued active surveillance (AS). The remaining 52 patients had a renal biopsy to help make their treatment decision - after the biopsy, 25 (48%) chose AS, 27 (52%) chose definitive treatment.
- Of cT1a, 55% chose AS
- Of cT1b, 13% chose AS
As more knowledge and safety of AS is gained, and as more physicians become comfortable with it, hopefully, its utilization will continue to increase. It is encouraging to see the use of renal biopsy (approximately 15% of patients). However, further work is needed to help ensure AS is offered as a first line therapy.
Dr. Coleman (MSKCC) asked the presenter and senior authors re: the intent of observation period – calling all these patients AS when the intent was not curative is inappropriate. Observation in a non-operative candidate is not considered AS – as is the case in prostate cancer. Yet, that information (intent) is not gleaned from the study.
Presented by: Brian Lane, MD, Ph.D., FACS, Spectrum Health; Michigan State University College of Human Medicine; Betz Family Endowed Chair for Cancer Research
Co-Authors: Alon Weizer, Tae Kim, Ji Qi, Ann Arbor, MI, Sanjeev Kaul, Royal Oak, MI, Edward Schervish, Troy, MI, Benjamin Stockton, St. Joseph, MI, Craig Rogers, Detroit, MI, for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI (the Michigan Urological Surgery Improvement Collaborative [MUSIC])
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA