Moderated Poster

Poster, Podium & Video Sessions

MP69-11: Patterns of Surveillance Intensity in Kidney Cancer

Monday, May 15
7:00 AM - 9:00 AM
Location: BCEC: Room 153

Presentation Authors: Suzanne Merrill*, Eric Schaefer, Chris Hollenbeak, Hershey, PA

Introduction: Multiple surveillance guidelines exist for kidney cancer following surgical intervention. Although these recommendations lack conformity, the majority do use stage as well as surgery type to stratify surveillance intensity. Due to guideline heterogeneity, it remains unclear what factors influence surveillance intensity in current practice. Our objective was to assess the patterns of surveillance intensity in kidney cancer after primary surgical intervention among patients ≥66 years.

Methods: Using SEER-Medicare, we identified patients diagnosed with non-metastatic kidney cancer who had undergone primary surgical intervention (n = 2433) from 2007 to 2011. Surveillance intensity was measured as the number of unique inpatient and outpatient claims made for kidney cancer (ICD-9 diagnosis code 189.0) starting 60 days after primary intervention. Using multivariable linear regression, we assessed the relationships between patient related factors and surveillance intensity (log-transformed). Parameters from the model were reported using risk ratios (RRs).

Results: Patients diagnosed in later years experienced more surveillance with an estimated 10% greater number of visits/12months occurring with each subsequent calendar year (RR 1.10 for every 1-year increase, 95% CI 1.07-1.13, p<0.001). As compared to pT1 stage, patients with pT2-4 disease experienced 108% more surveillance visits/12 months (RR 2.08, 95%CI 1.90-2.27, p<0.001). Both older age and living in a metro/urban area, as compared to a big metropolitan location, were associated with significantly fewer follow-up visits (10-year increase in age: RR 0.89, 95%CI 0.83-0.95, p<0.001; metro/urban: RR 0.86, 95%CI 0.79-0.93, p<0.001). Surgery type (radical, partial or ablation), gender, race and Charlson comorbidity score were not significantly associated with surveillance.

Conclusions: Similar to guidelines, surveillance intensity in current practice was found to correlate with disease stage. However, surgery type played less of a role. Other factors such as year of diagnosis, location and younger patient age were associated with more surveillance administered. Further analysis is warranted to understand the reasons for this variation in current surveillance practice and its impact on oncologic care.

Source Of Funding: None

Suzanne B. Merrill, MD

Penn State Milton S. Hershey Medical Center

Suzanne B. Merrill, M.D. is currently an Assistant Professor of Surgery and Urologic Oncologist in the Division of Urology at the Penn State Milton S. Hershey Medical Center. She is also the the associate program director for the urology residency at Penn State Hershey.

Dr. Merrill graduated summa cum laude from The University of Delaware where she received a bachelor of arts with honors in biology and chemistry. She attended The University of North Carolina Chapel Hill School of Medicine where she graduated with AOA honors. Dr. Merrill completed her urology residency at Duke University followed by a SUO accredited urologic oncology fellowship at The Mayo Clinic in Rochester, Minnesota. While at Mayo she also received a certificate in clinical and translational research science.

Dr. Merrill’s clinical practice focuses on utilizing both open and minimally-invasive techniques to treat all primary/recurrent urologic cancers. Her research interests revolve around individualizing urologic cancer surveillance following surgery to enhance patient satisfaction and promote value-based care. To date, she has co-authored over 35 manuscripts, book chapters, and editorials and serves as a reviewer for 3 journals.

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