Sociodemographic Disparities in the Nonoperative Management of Small Renal Masses

BACKGROUND: Local tumor ablation (LTA) and expectant management (EM) represent competing treatment modalities for patients with small renal masses (SRMs) who are unfit for surgery. We examined the potential social discrepancies in the access of LTA and EM.

MATERIALS AND METHODS: A total of 1860 patients with cT1a kidney cancer who had undergone either LTA (n = 553) or EM (n = 1307) from 2000 to 2009 were selected from the Surveillance, Epidemiology, and End Results-Medicare database. The baseline patient data (age, comorbidity status, defined as Charlson comorbidity index [CCI], and several sociodemographic variables) and tumor characteristics were examined. A multivariable analysis predicting access to LTA compared with EM was fitted. The subgroup analyses focused on patients aged ≥ 75 years with a CCI of ≥ 2.

RESULTS: Compared with LTA patients, the EM patients were significantly older (median age, 78 vs. 77 years; P < .001), more frequently unmarried (43% vs. 37%; P = .02), more frequently of African-American ethnicity (14% vs. 8%; P = .005), and more frequently of low socioeconomic status (SES; 55% vs. 46%; P = .001). No differences were seen according to gender, population density, CCI, or tumor size. In a multivariable analysis predicting access to LTA over EM, older age, African-American ethnicity, male gender, low SES, and unmarried status were associated with lower access to LTA (P ≤ .04 for all). In the subgroup of older and sicker patients, none of the previous sociodemographic characteristics represented barriers to LTA access (P ≥ .1 for all).

CONCLUSION: Sociodemographic characteristics might represent barriers to LTA access for patients with SRMs managed nonoperatively. However, these associations vanished when older and sicker patients were examined.