Page 1 - CUA2019 Abstracts - Oncology-Kidney
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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
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