title: Sociodemographic Disparities in the Nonoperative Management of Small Renal Masses.
abstract: BACKGROUND
  Local tumor ablation (LTA) and expectant management (EM) represent competing treatment modalities for patients with small renal masses (SRMs) who are unfit for surgery. We examined the potential social discrepancies in the access of LTA and EM.
  
  
  METHODS
  A total of 1860 patients with cT1a kidney cancer who had undergone either LTA (n = 553) or EM (n = 1307) from 2000 to 2009 were selected from the Surveillance, Epidemiology, and End Results-Medicare database. The baseline patient data (age, comorbidity status, defined as Charlson comorbidity index [CCI], and several sociodemographic variables) and tumor characteristics were examined. A multivariable analysis predicting access to LTA compared with EM was fitted. The subgroup analyses focused on patients aged ≥ 75 years with a CCI of ≥ 2.
  
  
  RESULTS
  Compared with LTA patients, the EM patients were significantly older (median age, 78 vs. 77 years; P < .001), more frequently unmarried (43% vs. 37%; P = .02), more frequently of African-American ethnicity (14% vs. 8%; P = .005), and more frequently of low socioeconomic status (SES; 55% vs. 46%; P = .001). No differences were seen according to gender, population density, CCI, or tumor size. In a multivariable analysis predicting access to LTA over EM, older age, African-American ethnicity, male gender, low SES, and unmarried status were associated with lower access to LTA (P ≤ .04 for all). In the subgroup of older and sicker patients, none of the previous sociodemographic characteristics represented barriers to LTA access (P ≥ .1 for all).
  
  
  CONCLUSIONS
  Sociodemographic characteristics might represent barriers to LTA access for patients with SRMs managed nonoperatively. However, these associations vanished when older and sicker patients were examined.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada. Electronic address: vincent.trudeau.1@umontreal.ca.
authors.forename: Vincent
authors.initials: V
authors.lastname: Trudeau
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Larcher
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Boehm
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Oglio
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Malek
authors.initials: M
authors.lastname: Meskawi
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: José
authors.initials: J
authors.lastname: Sosa
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fossati
authors.affiliation: Division of Oncology, Unit of Urology, Istituto di Ricerca, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada; Department of Urology, University of Montreal Health Center, Montreal, QC, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D055011:Ablation Techniques / Q000706:statistics & numerical data*; D001741:Black or African American / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007680:Kidney Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D009392:Nephrectomy / Q000706:statistics & numerical data; D018426:SEER Program; D012959:Socioeconomic Factors
keywords: Elderly patients; Kidney cancer; Local tumor ablation; Nonactive treatment; Sociodemographic disparities