Mixed methods assessment of providers’ needs in the management of advanced renal cell carcinoma.

Authors

Matthew Campbell

Matthew T Campbell

The University of Texas MD Anderson Cancer Center, Houston, TX

Matthew T Campbell , Patrice Lazure , Monica Augustyniak , Edgar A. Jaimes , Mehmet Asim Bilen , Emily Lemke , Ginny Jacobs , Pamela McFadden

Organizations

The University of Texas MD Anderson Cancer Center, Houston, TX, AXDEV Group, Brossard, QC, Canada, AXDEV Group Inc., Brossard, QC, Canada, Memorial Sloan Kettering Cancer Center, New York, NY, Emory University School of Medicine, Winship Cancer Institute of Emory University, Atlanta, GA, Medical College of Wisconsin Cancer Center, Milwaukee, WI, AXDEV Global, Inc., Virginia Beach, VA, AXDEV Global Inc., Virginia Beach, VA

Research Funding

Pharmaceutical/Biotech Company

Background: There is a paucity of data regarding the challenges associated with the timely and accurate diagnosis of Renal Cell Carcinoma (RCC) and its effective multidisciplinary management. This study aimed to assess the knowledge and skills of healthcare providers (HCPs) managing and coordinating the care of patients with advanced RCC (aRCC) across multidisciplinary teams. Methods: A sequential mixed methods needs assessment was conducted across the United States with medical oncologists (ONCs), nephrologists (NEPHs), physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs). Interviews, transcribed and thematically analyzed, and online surveys, statistically analyzed, were triangulated. Results: A total of 305 HCPs completed an interview (n=40) or the survey (n=265): 78 ONCs, 62 NEPHs, 57 PAs, 55 NPs, 53 RNs. One third (33%) of HCPs reported suboptimal skills in adjusting the dose of a treatment for aRCC in the event of adverse reactions. Interviews underscored a lack of clarity for HCPs on when to reduce the dose or when to discontinue and/or switch to other drugs. Suboptimal knowledge and skills related to toxicities were found (Table). Breakdowns in communication across multidisciplinary teams were identified by 46% of HCPs. Of those, 61% occurred when monitoring side effects and 48% when referring to ONCs. Some NEPHs reported never, rarely, or sometimes being involved with ONCs in the management of nephritis (25%), chronic kidney disease (19%), or acute renal failure (24%). Interviews suggested the role of NEPHs in the care of aRCC is poorly recognized and that NEPHs are perceived to have limited time to spend in the care of cancer patients. Few NEPHs reported gaps in knowledge/skills managing key renal complications such as nephritis (13%/15%), chronic kidney disease (6%/15%), and acute renal failure (9%/9%). Conclusions: This study identified a need to improve HCPs’ knowledge of the signs/symptoms of treatment side effects, skills in identifying/referring patients to appropriate specialists, and skills in managing adverse events. Barriers to involving NEPHs in the co-management of aRCC included a lack of recognition of their role in managing treatment-induced renal complications.These results should inform educational interventions for professionals caring for aRCC patients.

Percentage (%) of HCPs reporting suboptimal knowledge of signs and symptoms of treatment side effects (K-SE)/ skills identifying and referring such cases to specialist (S-ID).

ONCs

K-SE
NEPHs

K-SE
PAs

K-SE
NPs

K-SE
RNs

K-SE
ONCs

S-ID
NEPHs

S-ID
PAs

S-ID
NPs

S-ID
RNs

S-ID
Grade III and IV ulcerative colitis
42
58
47
38
40
42
53
45
52
31
Interstitial lung disease or pneumonitis
37
57
32
38
36
45
50
34
33
33
Hand-foot syndrome
29
59
28
40
42
32
50
50
38
40
Arthralgia
41
44
36
30
40
36
43
30
39
30
Mucositis
33
40
45
23
33
28
49
36
37
28
Uncontrolled hypertension
30
13
27
30
21
36
27
21
29
26
Fatigue
22
33
20
13
13
24
43
21
22
13

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Abstract Details

Meeting

2022 ASCO Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session C: Renal Cell Cancer; Adrenal, Penile, Urethral, and Testicular Cancers

Track

Renal Cell Cancer,Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Quality of Care/Quality Improvement and Real-World Evidence

Citation

J Clin Oncol 40, 2022 (suppl 6; abstr 313)

DOI

10.1200/JCO.2022.40.6_suppl.313

Abstract #

313

Poster Bd #

E3

Abstract Disclosures