SUO 2020: Evaluating the Psychosocial Impact of Kidney Cancer Treatments

(UroToday.com) During the kidney cancer session during the Society of Urologic Oncology (SUO), Dr. Cristiane Bergerot from the City of Hope provided a comprehensive overview of the interplay between psychosocial factors and renal cell carcinoma. The psychosocial effects of renal cell carcinoma (RCC) are profound, with 20% of patients experiencing depression and 30% experiencing anxiety. This is due to a myriad of causes such as treatment side effects, disease-related changes, as well as, finances and coping strategies.

Not only are these conditions distressing in and of themselves, but Dr. Bergerot went on to describe the impact these factors have on overall survival. She shared two pertinent studies, one by Prinsloo et al and another from her own group. Prinsloo et al., in 2015,  demonstrated an association between psychosocial factors and survival, finding that fewer depressive symptoms were shown to reduce the risk of death by 50% from metastatic RCC.¹ In her own group's work, they found a trend towards poorer overall survival in patients with higher distress as compared to those with lower distress.

Similarly, in the setting of localized RCC studies have explored the distress across all stages of disease. Her group recently published on patients’ self-reported distress and fear of cancer recurrence following treatment of localized RCC. Their group found a high prevalence of fear of cancer recurrence and distress in patients early in their survivorship. Interestingly, while distress improved over time, fear of cancer recurrence did not dissipate (Figure 1).²

Figure 1: Comparison between emotional well-being and time since diagnosis (quartile distribution). (A) Distress. (B) Fear of cancer recurrence.

Furthermore, in the advanced RCC setting, patients tend to harbor inaccurate expectations concerning the potential benefits of immunotherapy. Her group, previously found that a quarter of patients believed erroneously that a cure was likely following their treatment.  Interestingly, inaccurate expectations were associated with increased anxiety, demonstrating a clear area where managing expectations can have a profound impact on one's clinical course.

Lastly, she presented on tools to mitigate the emotional symptoms of cancer. In 2019 JCO published a meta-analysis of psychosocial treatment targeting fear of cancer recurrence finding that cognitive-behavioral therapy, psycho-education and mediative approach all had a robust effect on emotional symptoms. Lastly, as we move into a more digital age, many of these resources are available remotely and even at time without any clinician involvement increasing access for all of our patients.

In summary, psychosocial factors have been identified as a key predictor of survival and determinate of quality of life in RCC. Just as studies, focus on treatment-related side effects, Dr. Bergerot advocated for psychosocial factors to be a key outcome of future studies.

Presented by: Cristiane Bergerot, Ph.D., postdoctoral fellow, City of Hope National Medical Center, Los Angeles, California