Background: Until recently there has been no approved adjuvant therapy (AT) for renal cell carcinoma (RCC). Surveillance after nephrectomy is carried out with various modalities without clear recommendations from guidelines. In the S-TRAC trial, sunitinib improved disease-free survival (DFS) for high risk RCC patients (pts). Overall survival (OS) data is immature. Data on pts perception of AT vs surveillance are missing. The purpose of this study was to assess pts anxiety and perspectives regarding AT vs surveillance in RCC. Methods: We conducted a survey-monkey survey in n = 450 pts with RCC. The survey was promoted via kccure.org, Facebook and smartpatients.com. Questions focused on pts attitude towards AT. Results: Baseline pts characteristics include: median age 55.6 years (17-82 years); 56.4% female; 73.6% post-nephrectomy, 22.0% post-partial nephrectomy; 76.4% clear cell; 39.1% pts with RCC recurrence; 35.3% receiving systemic therapy for RCC. Median NCCN distress score was 6.39 in the majority of the pts. Main drivers of anxiety were cancer recurrence (74.4%), fear of the loss of renal function (38.7%), contrast media harming the kidney (27.1%) and exposure to radiation (20.7%). No differences in anxiety levels ranged between stage, age, gender, and type of surgery. Systemic therapy increased NCCN distress score (6.87, p < 0.0001). 63.1% of pts would use AT if it prolonged OS; 60.1% if AT prolonged DFS; 42.7% if AT demonstrated acceptable toxicity; 36.7% if guaranteed insurance coverage and efficacy. Use of systemic therapy correlated with a wish for a prolonged OS (p < 0.0001). Pts on systemic therapy had a significant higher acceptance of toxicity (p < 0.0001). Conclusions: Anxiety is a key driver for pts decisions and is unrelated to stage. Most pts are willing to use AT based on DFS benefits alone and place lower emphasis on toxicity. These data provide an important perspective on pts perceptions with RCC and the need for pts education on risks of AT.