Women are more likely than men and Black and Hispanic patients are more likely than White patients to receive kidney cancer treatments that deviate from accepted clinical guidelines, according to a recent study.

Compared with men, women had significant 18% lower odds of undertreatment and 27% higher odds of overtreatment in adjusted analyses, Jeffrey M. Howard, MD, PhD, of the University of Texas Southwestern Medical Center in Dallas, Texas, and colleagues reported in JAMA Network Open.

“One might question whether there are underlying clinician-driven or patient-driven reasons for this disparity,” the investigators wrote. “For example, there may be a tendency of clinicians to perceive female patients as having greater potential longevity and therefore warranting more aggressive cancer treatment. Alternately or concurrently, there may be a systematic preference among female patients for more aggressive treatment.”

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Compared with White patients, Black and Hispanic patients had significant 42% and 20% increased odds of undertreatment, respectively, and 9% and 6% increased odds of overtreatment.

In addition, patients who were uninsured had significant 2.6-fold higher adjusted odds of undertreatment and 28% lower odds of overtreatment compared with insured patients.

The investigators noted that, to their knowledge, their study represents the first attempt to assess the associations between demographic factors and receipt of non-guideline-based treatment among patients with kidney cancer.

“We found that female patients had higher odds of receiving more aggressive treatment than men, which was associated with increased rates of overtreatment for small kidney masses and potentially increased risk for unjustified complications,” Dr Howard and colleagues concluded. “Black race and Hispanic ethnicity were associated with higher odds of undertreatment and overtreatment, highlighting the bidirectional nature of inequities in treatment.”

Using 2010-2017 data from the National Cancer Database, the investigators studied 158,445 patients treated for localized kidney cancer, of whom 99,563 (62.8%) were men, 120,001 (75.7%) were White, and 91,218 (57.6%) had private insurance.

Dr Howard and colleagues assigned patients to 1 of 4 tumor classifications based on tumor size and clinical stage and categorized patients as receiving guideline-based treatment or under- or overtreatment. For tumors less than 2 cm in diameter, guideline-based treatment would be surveillance and overtreatment would be ablation or partial or radical nephrectomy. For tumors 2-4 cm in diameter, guideline-based treatment would be surveillance, ablation, or partial nephrectomy and overtreatment would be radical nephrectomy. For tumors 4-7 cm and larger than 7 cm, partial or radical nephrectomy would be guideline-based treatment and surveillance or ablation would be undertreatment.

Of the study cohort, 3893 patients (2.5%) were undertreated and 44,651 (28.2%) were overtreated.


Howard JM, Nandy K, Woldu SL, Margulis V. Demographic factors associated with non-guideline-based treatment of kidney cancer in the United States. JAMA Netw Open. Published online June 9, 2021. doi:10.1001/jamanetworkopen.2021.12813