title: Health status and use of partial nephrectomy in older adults with early-stage kidney cancer.
abstract: The long-term benefits of nephron-sparing surgery for kidney cancer depend on patient health. Accordingly, we examined whether receipt of partial nephrectomy varied with baseline comorbidity or functionality among older adults with stage I kidney cancer.
  
  
  
  Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 to 2009, we identified patients treated with partial or radical nephrectomy for stage I kidney cancer. We examined treatment trends according to baseline comorbidity, function, and relevant health conditions. We then estimated the probability of partial nephrectomy using multivariable, mixed-effects models adjusting for patient, surgeon, and hospital characteristics.
  
  
  
  Overall, 2,956 of 11,678 patients (25.3%) underwent treatment with partial nephrectomy. Receipt of partial nephrectomy was associated with younger age, male sex, higher socioeconomic position, smaller tumor size, and treatment by a high-volume provider, cancer center, or academic institution (P<0.001). During the study period, utilization increased significantly (P<0.001) but did not differ according to comorbidity or patient function. Adjusting for patient, surgeon, and hospital characteristics, the probability of partial nephrectomy by comorbidity and function categories remained within a narrow range from 19.6% to 22.8%. Only preexisting kidney disease appeared to be linked to partial nephrectomy usage (odds ratio = 1.49, 95% CI: 1.33-1.66).
  
  
  
  With the exception of kidney disease, the increasing use of partial nephrectomy did not vary with respect to health status. As the potential benefits of partial nephrectomy differ according to a patient׳s underlying health, selection tools and algorithms that match treatment to patient comorbidity or function may be needed to optimize kidney cancer care in the United States.
authors.affiliation: Department of Urology, University of North Carolina, Chapel Hill, NC. Electronic address: hjtan@med.unc.edu.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Daskivich
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Shirk
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA; UCLA School of Nursing, Los Angeles, CA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.affiliation: Department of Urology, Weill Cornell School of Medicine, New York, NY.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011379:Prognosis; D018426:SEER Program; D015996:Survival Rate
keywords: Comorbidity; Health status; Kidney neoplasm; Nephrectomy