In an interview with the Journal of Clinical Pathways at the ASCO 2023 Annual Meeting, Regina Barragán-Carrillo, MD, City of Hope Comprehensive Cancer Center, discusses her study on the influence of race and payor status on the treatment patterns of partial versus radical nephrectomy procedures among patients with renal cell carcinoma, highlighting the importance of access to care for these patients.

Transcript:

Regina Barragán-Carrillo, MD: My name is Regina Barragan-Carrillo. I am currently a medical oncologist affiliated with the City of Hope Comprehensive Cancer Center.

Can you give some background about your study and what prompted you to undertake it?

Dr Barragán-Carrillo: So in the last couple of years, we have seen an increase in the diagnosis of localized renal cell carcinoma, particularly in the last four years. It has been an increase of about eight cases every hundred thousand people. So it's definitely a problem that's been noted in the last couple of years. And it is also described that some social minorities such as ethnic and racial minorities do not always get the same care as other majority groups. For example, as for breast cancer and also for bladder cancer, these type of patients do not usually get as many conservative surgeries as radical ones.

Can you briefly describe how the study was conducted?

Dr Barragán-Carrillo: So we looked at the California OSHPA database. The OSHPA collects data from all inpatient and outpatient patients, as well as all procedures and ER department visits. So we looked at the data and we specifically wanted to know the rate of partial versus radical nephrectomy taking into account the racial and ethnic group as well as the payer status.

What were the key findings of your study?

Dr Barragán-Carrillo: So overall, we collected data for a little over 31,000 people. So the demographic data was actually very similar to what we expected from other studies. Most were male, about 57%. The mean age of diagnosis was around 57 years old. And as for the ethnic groups, most [patients] were non-Hispanic White, followed by Hispanic, finally, Black and Asian. And for the payer status around one-third were private insurance, and the rest had either insurance with Medicare or Medicaid. And finally a little proportion of patients, around 10%, were insured through a different setting, for example, veterans.

And also an important factor that we looked into in our study was the incidence of comorbidities. For example, hypertension was present in around one-third of our patients, followed by diabetes in 16%, chronic kidney disease in less than 10%, and finally frailty in less than 1%. And the setting in where the nephrectomies were performed, especially non-academic centers that were most patients around 57%, versus academic centers around 43%.

So our main findings when we were looking at ethnic and racial groups, it was a considerable increase in the use of radical nephrectomies in the racial and ethnic minorities, such as, for example, when comparing with non-Hispanic White [patients], they had around 53% of partial nephrectomy. And the other group, for example, Hispanic [patients] had 47%, Asian [patients] had around 46%, and Black patients had 44% in the uptake of partial nephrectomy. And it is important because it is well described that these patients have very similar oncology outcomes, but the use of radical nephrectomies has been more associated with the development of chronic kidney disease as well as other cardiovascular complications.

And as for the payer status, it was also very noteworthy looking that those patients that were privately insured had around a 57% rate of partial nephrectomy when comparing, for example, patients who had Medicare and Medicaid in which rate of partial nephrectomy was lower than 40%. So it is important to note that our findings, at least on the side of the ethnic and racial groups, were consistent by both univariate and multivariate analysis. And as for the payer status was only positive under univariate analysis.

Looking ahead, what potential impact do you hope your findings will have on addressing disparities in access to care?

Dr Barragán-Carrillo: So as health care providers, we truly believe that our findings must be very considered as a way to understand that not all ethnic minorities are receiving the same care, and we must be aware of our own unconscious bias as health care providers. So it is important to note, and I want to disclose that we currently do not have granular data that support our findings in a more specific way. For example, we lack the size of the tumors or the latency of diagnoses, or the complexity. Nonetheless, we truly believe that the consistency of our findings with other previously published literature, they currently support the use of lesser invasive procedures in minority populations.

Is there anything else you'd like to add?

Dr Barragán-Carrillo: At the end of the day, it's important to look at data to finally address disparities together as healthcare providers, and also to practice cultural humility so we can encourage our patients to look for the best care for themselves and their loved ones.