Presentation Authors: Tariq A. Khemees*, Anthony Bui, Daniel D. Shapiro, Sara L. Best, Shane A. Wells, Timothy J. Ziemlewicz, Meghan G. Lubner, James Louis Hinshaw, Fred T. Lee Jr, David F. Jarrard, Kyle A. Richards, Tracy M. Downs, Stephen Y. Nakada, E. Jason Abel, Madison, WI
Introduction: Shared decision making is important for patients who are considering treatment of small renal masses (SRM). The purpose of this study was to compare patient&[prime]s opinions with surgeon perspectives regarding the use of pre-treatment SRM biopsy.
Methods: A 5 question survey was given to 100 consecutive patients with SRM before and after treatment discussion. The patient survey contains questions about anxiety level (visual analog scale) and whether patients believed biopsy would be helpful make decision about treatment. In addition to patient survey, a 10 question surgeon survey was linked to email sent to active members of the Society of Urologic Oncology. Respondents were grouped based on date of completion of training, type of practice, and geographic location.
Results: A total of 100 consecutive patients completed a survey prior to discussion of SRM treatment. Pre-discussion anxiety was high with 46% of patients responding that SRM diagnosis was &[Prime]among most stressful moments in life&[Prime] When patients were asked &[Prime]Would knowing whether or not there is cancer in your renal mass help you to make a decision about treatment?&[Prime], 81% answered yes. When asked if they would consider biopsy, 84% answered yes. After renal mass counseling, only 46% of patients answered yes to &[Prime]did you decide to have a biopsy?&[Prime]. A total of 42/100 patients subsequently received biopsy. _x000D_
Of 717 surgeons who were emailed, 111(15.5%) completed the online survey. Practice type included: Academic (76%), private (18%) and military/government (6%). The median year when training was completed was 2009 (IQR 2000-2015) and 62% of respondents evaluating ≥5 SRM/month. When asked how often biopsy is recommended for SRM, 60% recommend biopsy < 25% of SRM patients, 20% recommend biopsy for half of SRM patients and 20% recommend biopsy greater for than 75% of SRM._x000D_
Training year and type of practice were not associated with how frequently biopsy was recommended (p=0.27, 0.17). Common responses for the advantage of using biopsy to evaluate SRM included: To identify benign tumors and avoid treatment (49%), to risk stratify renal cancer patients prior to treatment (21%), and to improve informed consent prior to treatment (14%). The most common response for why biopsy was not recommended is that it would not change management (86%).
Conclusions: Before counseling, most SRM patients favor biopsy. After treatment discussion, less than half of patients favored biopsy with 42% subsequently receiving biopsy. Practice patterns remain variable among surgeons, with 40% of respondents recommending biopsy for at least half of SRM evaluated.