Demographic factors such as sex, race, or ethnicity were associated with receipt of non-guideline-based treatment, according to a study of patients with kidney cancer in the United States. The study findings were reported in JAMA Network Open.

“To our knowledge, this study represents the first attempt to assess the associations between demographic factors and receipt of non-guideline-based treatment among patients with kidney cancer,” the study investigators wrote in their report.

In this retrospective cohort study, patients with localized kidney cancer were found through the National Cancer Database. Patients included in this analysis were aged 30 to 70 years, had Charlson-Deyo Comorbidity Index scores of 0 or 1, and were treated at US health care facilities that were accredited by the Commission on Cancer. The goal of the study was to ascertain any patterns in receipt of non-guideline-based kidney cancer treatment.

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Data from 158,445 patients with localized kidney cancer were evaluated. Nearly one-third (30.6%) of patients had received non-guideline-based treatment. In an adjusted analysis, compared with male patients, female patients were less likely to be undertreated (odds ratio [OR], 0.82; 95% CI, 0.77-0.88; P <.001) and more likely to be overtreated (OR, 1.27; 95% CI, 1.24-1.30; P <.001).

Compared with White patients, Black and Hispanic patients showed patterns of both undertreatment and overtreatment in an adjusted analysis. Black patients had an OR for undertreatment of 1.42 (95% CI, 1.29-1.55; P <.001), and an OR for overtreatment of 1.09 (95% CI, 1.05-1.13; P <.001). For Hispanic patients, the OR for undertreatment was 1.20 (95% CI, 1.06-1.36; P =.004), and the OR for overtreatment was 1.06 (95% CI, 1.01-1.11; P =.01).

In a comparison with patients who had private insurance, uninsured patients showed higher odds of undertreatment (OR, 2.63; 95% CI, 2.29-3.01; P <.001) and lower odds of overtreatment (OR, 0.72; 95% CI, 0.67-0.77; P <.001) in an adjusted analysis.

The study investigators concluded that disparities in non-guideline-based treatment of kidney cancer exist based on female sex, Black race, and Hispanic ethnicity. “Clinicians should bear these disparities in mind when counseling individual patients, and health policy makers should take the existence of these disparities into account,” they wrote in their report.


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. 2021;4(6):e2112813. doi:10.1001/jamanetworkopen.2021.12813