(UroToday.com) The 2022 International Kidney Cancer Symposium (IKCS) European Annual meeting included a session addressing non-clinical considerations for caring for the whole kidney cancer patient and a presentation by Dr. Theresa Junker discussing quality of life after renal cell carcinoma (RCC) treatment. Dr. Junker notes that according to the World Health Organization, quality life is “A state of complete physical, mental and social well-being and not merely the absence of disease.” Given that the incidence of RCC is increasing with age, it is important to discuss the quality of life among kidney cancer patients. An increasing pace of an aging population brings a focus on healthy life expectancy, particularly since the estimated cancer-specific survival for localized RCC is 62-86%.
Dr. Junker then highlighted several key papers that address quality of life/assessing life expectancy among elderly kidney cancer patients for localized disease. MacLennan et al.1 systematically reviewed all the published literature up to January 2012, comparing perioperative and quality of life outcomes of surgical management of localized RCC (T1-2N0M0). Among 29 studies that met inclusion criteria (7 RCTs and 22 non-randomized studies), there was good evidence indicating that partial nephrectomy results in better preservation of renal function and better quality of life outcomes than radical nephrectomy regardless of technique or approach. Specific to radical nephrectomy, a laparoscopic approach has better perioperative outcomes than an open approach, and there is no evidence of a difference between the transperitoneal and retroperitoneal approaches. Alternatives to standard laparoscopic radical nephrectomy such as hand-assisted, robot-assisted, or single-port techniques appear to have similar perioperative outcomes. Additionally, there is no good evidence to suggest that minimally invasive procedures such as cryotherapy or radiofrequency ablation have superior perioperative or quality of life outcomes to nephrectomy. As follows is the forest plot from this study for return to work at 2 weeks post-operatively:
In 2018, Rossi et al.  performed an updated literature review to evaluate the evidence regarding health-related quality of life following different management strategies for localized RCC. They found that laparoscopic nephrectomy was associated with significantly better short-term physical function compared to open surgery, although the effect on mental function was not conclusive. Additionally, nephron-sparing surgery was associated with better physical function compared to radical nephrectomy. Tumor size, stage, post-operative complications, age, body mass index, occupational status, educational level and comorbidities were significant predictors of health-related quality of life. Of note, there was little data available regarding the impact of follow-up protocols and long-term effects of cancer survivorship.
Earlier this year, Dr. Junker and colleagues published their systematic review  investigating quality of life and complications after nephron-sparing treatment of renal cell carcinomas of stage T1. Among 8 included studies, three reported higher quality of life scores after partial nephrectomy compared to radical nephrectomy, and two studies showed that quality of life increased or returned to baseline levels up to 12 months following partial nephrectomy. One study reported a gradual increase in quality of life after radiofrequency ablation, and one study reported that all patients recovered to baseline quality of life following cryoablation. Furthermore, there was a reported complication rate of up to 20% after partial nephrectomy and up to 12.5% after ablation therapy.
Dr. Junker highlighted that the measurement tools we typically use for these patients are subdivided as follows:
- Generic questionnaires: SF-36, SF-12, EQ-5D, HADS, SPQ, GHQ
- Cancer specific questionnaires: FACT-G, EORTC QLQ C30, fear of recurrence
- Renal cancer questionnaires: FKSI, RCC-SI
According to Dr. Junker, what we need is expanded use of validated measurement tools, prospective randomized studies with long-term follow-up, and quality of life outcomes should be included in all clinical studies. Dr. Junker concluded her presentation by discussing the quality of life after RCC treatment with the following summary points:
- There is significant heterogeneity among available studies regarding design, measurement tools, and patient population
- Nephron-sparing treatment appears to be superior or comparable to other treatment alternatives
- Minimally invasive treatment has the least negative impact on short-term quality of life
Presented By: Theresa Junker, PhD, Department of Radiology, Odense University Hospital, Klovervaenget, Odense C, Denmark
Written By: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 International Kidney Cancer Symposium (IKCS) Europe Annual Hybrid Meeting, Antwerp, Belgium, Fri, Apr 22 – Sun, Apr 24, 2022.
- MacLennan S, Imamura M, Lapitan MC, et al. Systematic review of perioperative and quality-of-life outcomes following surgical management of localized renal cancer. Eur Urol. 2012;62(6):1097-1117.
- Rossi SH, Klatte T, Stewart GD. Quality of life outcomes in patients with localized renal cancer: A literature review. World J Urol. 2018 Dec;36(12):1961-1972.
- Junker T, Duus L, Rasmussen BSB, et al. Quality of life and complications after nephron-sparing treatment of renal cell carcinoma stage T1: A systematic review. Syst Rev. 2022 Jan 4;11(1):4.