As treatment options for metastatic renal cell carcinoma (mRCC) have increased, selecting a form of therapy has become more complicated for patients. Guidelines currently recommend selection based mainly on risk classification, along with consideration of efficacy data, patient characteristics, quality of life (QOL), cost, and patient preference.
A study that will be presented at the American Society of Clinical Oncology 2023 Annual Meeting surveyed patients to determine how they prioritize treatment selection, as well as how treatment success is defined, to improve communication between patients and their providers and improve future treatment development.
A survey developed by the Kidney Cancer Research Alliance for patients with RCC was distributed via the organization’s website, mailing lists, and social media platforms between July 2022 and September 2022. Patients were surveyed for demographics and clinical characteristics. Of the 1062 patients who took the survey, 399 had metastatic disease. A total of 80% of patients were receiving or had received systemic therapy, while 20% of patients had not yet received systemic therapy. The median age of the patient group was 57 years (range, 28-86 years); 52% were female and 48% were male. Most patients identified as White (89%) and were living in the United States (86%). When surveyed about their risk status, 69% of patients reported that they did not know, 10% were favorable risk, 11% were intermediate risk, and 10% were poor risk.
When asked to select the most important outcome for treatment selection on a scale from 1 to 8, the chance of achieving complete response scored the highest (6.6), followed by durability of response (5.1), improved QOL (5.0), rapid reduction of tumors (4.9), ability to go off therapy (4.2), low toxicity risk (4.0), and reduction of tumor symptoms (4.0). Patients ranked low treatment cost as the least important factor in selecting treatment (2.3). A total of 70% of patients defined “long-term” response to therapy as 5 years or longer, and 26% of patients defined long-term response as 10 years or longer.
When asked to define treatment success, patients ranked radiological reduction in tumor size (83%) as the most important factor, followed by stable disease (67%), improved QOL (48%), and the ability to return to work (22%). The lowest-ranked choice was “I just trust my doctor” (17%).
Many patients are not familiar with their personal risk classification and may not realize the significance of this factor when it comes to their treatment selection. Patients viewed complete response as the most important outcome/desire when considering treatment options, while cost was the least important factor. Patient perceptions of long-term response to therapy may differ from provider perceptions. More research is needed to improve patient/provider communication during the therapy selection process.