Nonclinical Factors Predict Selection of Initial Observation for Renal Cell Carcinoma.
OBJECTIVE
To determine the rate of observation utilization over time and to identify factors influencing its use.


METHODS
Using the National Cancer Data Base, we studied observation utilization in patients diagnosed with localized renal cell carcinoma from 2003 to 2010. Relationships between temporal, demographic, provider, and clinical factors and the likelihood of observation were evaluated using multivariate logistic regression.


RESULTS
Of 109,410 analyzed patients, 7047 (6.4%) underwent observation with stable use over time (range, 6.1% to 6.8%). Patient and disease factors were the strongest predictors of observation. Specifically, the odds of biopsy were 1.8-11 times higher for elderly or comorbid patients and 1.6-8.4 times higher for small (clinical T1a), biopsied, or bilateral tumors (P <.01 for all). Racial and socioeconomic factors also significantly predicted observation usage. In particular, observation rates were higher among poor, African American, and uninsured or socially insured patients, with these groups having 1.2-3.5 times higher odds of observation (P <.01). Patients receiving care at community, low-volume, or nearby hospitals were also significantly more likely to undergo observation (P <.01).


CONCLUSIONS
Despite the continued rise in the incidence of incidental renal masses, initial observation use has remained stable. In accordance with treatment guidelines, observation is preferentially utilized in elderly and comorbid patients. However, nonclinical factors also predict observation use, suggesting that utilization may be influenced by racial and socioeconomic disparities in health care quality.
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
Matthew J
MJ
Maurice
Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
Hui
H
Zhu
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH; Division of Urology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
Jonathan E
JE
Kiechle
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH.
Simon P
SP
Kim
Urology Institute, University Hospitals Case Medical Center, Cleveland, OH. Electronic address: robert.abouassaly@uhhospitals.org.
Robert
R
Abouassaly
D000368:Aged; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D057832:Watchful Waiting / Q000379:methods / Q000706:statistics & numerical data*