Page 1 - CUA2019 Abstracts - Oncology-Kidney
P. 1
2019 CUA AbstrACts
Poster Session 9: Kidney, Penis, and Testis Cancer
July 1, 2019; 0730–0900
MP-9.1 ment) cohort, we perform a cost-effectiveness analysis of renal biopsy to alter
Development of a patient decision aid for the management of management in patients who have (would have) undergone intervention.
small renal masses Methods: We completed a decision analysis populated by a multi-
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Kristen McAlpine , Rodney H. Breau , Dawn Stacey , Christopher institutional, multi-provincial Canadian cohort from 2013–2015 (Fig. 1,
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Knee , Michael A. Jewett , Ilias Cagiannos , Christopher Morash , Luke TreeAgePro software). Outcomes and cost data were compared against
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T. Lavallée 1,2 reference literature values for generalizability to other jurisdictions. Non-
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1 Division of Urology, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa diagnostic biopsies were re-biopsied once. Given our low event rate and
Hospital Research Institute, Ottawa, ON, Canada; School of Nursing, risk of bias, literature rates were used for false negative and false positive
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University of Ottawa, Ottawa, ON, Canada; Departments of Surgery (Urology) biopsy rates.
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and Surgical Oncology, Princess Margaret Cancer Centre, University Health Results: Of 542 patients, 192 (35%) received preoperative biopsy and 58
Network and the University of Toronto, Toronto, ON, Canada (10.7%) had benign disease on nephrectomy pathology. Fourteen (7.3%)
Funding: IKCC, KCRNC-CUOG, CUASF, TOHAMO had discordant pathology between biopsy and nephrectomy; however,
Introduction: Patients with small renal masses are candidates for surgery, many of these would not have altered management (renal cell carcinoma
ablation, or surveillance. The choice of management requires an assessment subtype misclassification). Seven (3.6%) were non-diagnostic. Using final
of benefits and risks of each option and incorporation of patients’ values. We pathology as gold standard and accounting for biopsy accuracy, we found
sought to develop a patient decision aid to facilitate shared decision-making a number needed to biopsy (NNTB) of 10.4 biopsies per nephrectomy
and patient-centred care for individuals with small renal masses. avoided. Results were most sensitive to parameter uncertainty around
Methods: A structured development process was used following the probability of benign disease, cost of surgery and of biopsy. After 50 000
International Patient Decision Aid Standards and the Ottawa Decision simulations, biopsy was cost-saving ($11 933 vs. $12 416, threshold 6.9%
Support Framework. A literature review was performed to identify out- likelihood of preoperative benign disease). In subanalysis of non-biopsy
comes related to the management of small renal masses. An iterative feed- centres (16% benign disease), cost savings increased and NNTB fell to 7.0.
back process by a steering committee of content and process experts was Conclusions: Even prior to incorporating quality of life benefits from avoid-
used to determine the draft decision aid content. Figures and narrative text ing unnecessary operating rooms and surgical complications, we demon-
were developed to explain management options and outcome rates. A strate the clinical and cost-effectiveness of incorporating renal biopsy as a
10-question survey was created to assess the acceptability of the decision useful preoperative planning tool.
aid with patients, patient advocates, urologists, and methodological experts. This paper has a figure, which may be viewed online at:
Results: An evidence-based decision aid was created. Management options https://2019.cua.events/webapp/lecture/208
included were partial nephrectomy, radical nephrectomy, ablation, and
surveillance. Benefits included were rates of overall survival, metastasis- MP-9.4
free survival, and length of hospital stay. Risks included were rates of Incidence and management of penile cancer in Manitoba: A
post-procedural urine leak, bleeding, and renal failure. A validated tool 10-year experience
was included to explore patients’ values and preferences. Pictures, dia- Samir Ksara , Darrel E. Drachenberg , Robert H. Wightman
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grams, and plain language were used to allow use by patients of various 1 Urology, University of Manitoba, Winnipeg, MB, Canada; Pathology,
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educational backgrounds. Knowledge questions were included to assess University of Manitoba, Winnipeg, MB, Canada
patients’ understanding. The decision aid met the International Patient Introduction: Squamous cell carcinoma (SCC) of the penis is a relatively
Decision Aids Standards defining (6 of 6), certification (6 of 6), and qual- rare malignancy in the Western world, with an incidence of less than
ity criteria (17 of 23). one case per 100 000 men per year. Early lymphadenectomy in high-risk
Conclusions: A novel patient decision aid was created for the manage- patients is paramount in managing the disease. The primary objective of
ment of small renal masses following a systematic and evidence-based this study is to assess the patterns of practice and adherence to guidelines
process. Acceptability testing is being performed in a prospective fashion in the management of SCC in Manitoba. The secondary objective is to
with stakeholders. determine incidence, stage at presentation, and pathological characteristics
of the disease in this population.
MP-9.2 Methods: Using the provincial pathology data, we were able to identify all
Renal biopsy: When will it change management? penile cancer specimens taken from 2007–2017. We then conducted a retro-
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Douglas C. Cheung , Patrick Richard , Diana E. Magee , Luke T. Lavallée , spective electronic chart review of each patient diagnosed with the disease.
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Frédéric Pouliot , Maria Komisarenko , Lisa Martin , Jean-Baptiste Lattouf , Results: We identified 83 new cases of penile cancer from 2007–2017
Shabbir M. Alibhai , Murray Krahn , Antonio Finelli 1 corresponding to an age-adjusted incidence rate of 1.5 per 100 000 men
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1 Urology, University of Toronto, Toronto, ON, Canada; Urology, Université per year. Approximately 49% of patients were found to have T2 disease or
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de Sherbrooke, Sherbrooke, QC, Canada; Urology, University of Ottawa, higher on presentation. A large proportion of patients met the criteria for
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Ottawa, ON, Canada; Urology, Université Laval, Québec City, QC, Canada; early inguinal exploration (45%) but only 5% of these patients underwent
5 Urology, Centre Hospitalier de l’Université de Montréal, Montréal, QC, the procedure. Pathology reports were incomplete in 36%, and 12% were
Canada; Internal Medicine, University of Toronto, Toronto, ON, Canada missing key information that would have impacted management.
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Introduction: Despite strong safety and accuracy data, renal biopsy use Conclusions: The incidence of penile SCC in Manitoba is significantly
remains low. Proponents of no-biopsy argue that it would not change man- higher than the national average. A large proportion of patients with high-
agement since biopsy cohorts in existing studies may not be representative risk disease were undertreated.
of those progressing to treatment. In a multi-institutional nephrectomy (treat-
S140 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association