Disparities in Treatment Decision-Making for Patients With Kidney Cancer

Study findings show increased rates of non-guideline-based treatment among women and Black and Hispanic patients with kidney cancer (JAMA Netw Open. 2021;4[6]:e2112813. doi:10.1001/jamanetworkopen.2021.12813).

“Significant demographic disparities have been found to exist in the delivery of health care. Demographic factors associated with clinical decision-making in kidney cancer have not been thoroughly studied,” wrote Jeffrey M. Howard, MD, PhD, Department of Urology, University of Texas Southwestern Medical Center, Dallas, and colleagues.

This study aimed to identify demographic factors associated with receipt of non-guideline-based treatment for kidney cancer.

Data from the National Cancer Database from 2010 through 2017 were used to identify patients aged 30 to 70 years with localized kidney cancer and no major medical comorbidities treated at Commission on Cancer-accredited health care institutions in the United States. Data were analyzed from November 2020 through March 2021.

A total of 158,445 patients were treated for localized kidney cancer between 2010 and 2017. Of these patients, 99,563 (62.8%) were men, 120,001 (75.7%) were White, and 91,218 (57.6%) had private insurance. Overall, 48,544 (30.6%) patients received non-guideline-based treatment.

Female sex was associated with lower adjusted odds of undertreatment (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P <.001) and higher adjusted odds of overtreatment (OR, 1.27; 95% CI, 1.24-1.30; P <.001) compared with male sex. Additionally, Black and Hispanic patients had higher adjusted odds of undertreatment (Black patients: OR, 1.42; 95% CI, 1.29-1.55; P <.001; Hispanic patients: OR, 1.20; 95% CI, 1.06-1.36; P = .004) and overtreatment (Black patients: OR, 1.09; 95% CI, 1.05-1.13; P <.001; Hispanic patients: OR, 1.06; 95% CI, 1.01-1.11, P = .01), compared with White patients.

Patients who were uninsured had statistically significantly higher adjusted odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P <.001) and lower adjusted odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P < .001), compared with those who had insurance.

“This study found that there were significant disparities in treatment decision-making for patients with kidney cancer, with increased rates of non-guideline–based treatment for women and Black and Hispanic patients,” concluded Dr Howard and colleagues.

“These findings suggest that further research into the mechanisms underlying these disparities is warranted and that clinical and policy decision-making should take these disparities into account,” they added.—Janelle Bradley