title: Renal cell cancer: a shift in approaches for treatment of advanced disease in the United States.
abstract: Several new agents have become available to treat renal cell cancer (RCC) in recent years, although evidence on their dissemination is limited. This study examined recent trends in RCC treatment in US community practices. Data from the population-based National Cancer Institute's Patterns of Care studies were used to evaluate treatment of patients with RCC newly diagnosed in 2004 and 2009 (N=2357). Descriptive statistics and logistic and Cox proportional hazards regression analyses were used to assess treatment patterns and the associations among demographic, clinical, and hospital characteristics, with receipt of systemic therapy and time-to-systemic treatment. Between 2004 and 2009, systemic therapy use increased among patients with stage III and IV RCC, from 3.8% to 15.7% and 35.2% to 57.4%, respectively. Among patients with stage IV disease, the most commonly used therapies changed from interleukin-2 (16.3%) and interferon-alfa (16.6%) in 2004 to sunitinib (39.2%) and temsirolimus (15.2%) in 2009. Further, notable decreases were seen in the use of surgery and time-to-systemic treatment for patients with stage IV disease. Patients who were older, living in areas with lower educational attainment, and diagnosed in 2004 were significantly less likely to receive systemic therapy and had longer time-to-systemic treatment (P<.05). The findings indicate that over the past decade, treatment for RCC in the United States has evolved toward increased use of systemic therapy. As the diffusion of new therapies continues, it will be imperative to understand how variation in care for RCC will impact health outcomes and costs of care.
authors.affiliation: From the Divisions of Cancer Control and Population Sciences and Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Banegas
authors.affiliation: From the Divisions of Cancer Control and Population Sciences and Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.affiliation: From the Divisions of Cancer Control and Population Sciences and Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Mann
authors.affiliation: From the Divisions of Cancer Control and Population Sciences and Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland.
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology