title: A Prospective, Comparative Study of Quality of Life among Patients with Small Renal Masses Choosing Active Surveillance and Primary Intervention.
abstract: To our knowledge quality of life has not been evaluated in rigorous fashion in patients undergoing active surveillance for small renal masses. The prospective, multi-institutional DISSRM (Delayed Intervention and Surveillance for Small Renal Masses) Registry was opened on January 1, 2009, enrolling patients with cT1a (4.0 cm or less) small renal masses who elected primary intervention or active surveillance.
  
  
  
  Patients were enrolled following a choice of active surveillance or primary intervention. The active surveillance protocol includes imaging every 4 to 6 months for 2 years and every 6 to 12 months thereafter. The SF12® quality of life questionnaire was completed at study enrollment, at 6 and 12 months, and annually thereafter. MCS (Mental Component Summary), PCS (Physical Component Summary) and overall score were evaluated among the groups and with time using ANOVA and linear regression mixed modeling.
  
  
  
  At 82 months among 3 institutions 539 patients were enrolled with a mean ± SD followup of 1.8 ± 1.7 years. Of the patients 254 were on active surveillance, 285 were on primary intervention and 21 were on active surveillance but crossed over to delayed intervention. A total of 1,497 questionnaires were completed. Total and PCS quality of life scores were better for primary intervention at enrollment through 5 years. There were generally no differences in MCS scores among the groups and there was a trend of improving scores with time.
  
  
  
  In a prospective registry of patients undergoing active surveillance or primary intervention for small renal masses those undergoing primary intervention had higher quality of life scores at baseline. This was due to a perceived benefit in the physical health domain, which persisted throughout followup. Mental health, which includes the domains of depression and anxiety, was not adversely affected while on active surveillance, and it improved with time after selecting a management strategy.
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: hitenpatel@jhmi.edu.
authors.forename: Hiten D
authors.initials: HD
authors.lastname: Patel
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Riffon
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Joice
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Johnson
authors.affiliation: Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Peter
authors.initials: P
authors.lastname: Chang
authors.affiliation: Division of Urology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wagner
authors.affiliation: Department of Urology, Columbia University Medical Center, New York, New York.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mohamad E
authors.initials: ME
authors.lastname: Allaf
authors.affiliation: The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Pierorazio
mesh_terms: D000328:Adult; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D047368:Tumor Burden; D057832:Watchful Waiting
keywords: carcinoma; early medical intervention; kidney neoplasms; quality of life; renal cell; watchful waiting