Understanding Hospital-Level Patterns of Nonoperative Management for Low-risk Thyroid and Kidney Cancer

Area of Science:

• Oncology
• Health Services Research
• Cancer Management

Background:

• Conservative management is increasingly favored for select low-risk cancers.
• Hospital and health system factors may influence treatment decisions for these patients.
• Understanding these influences is crucial for optimizing patient care pathways.

Purpose of the Study:

• To investigate the impact of hospital-level factors on the likelihood of nonoperative management for low-risk cancers.
• To compare nonoperative management rates across different healthcare facilities for specific low-risk malignancies.

Main Methods:

• Cross-sectional study analyzing data from the National Cancer Database (2015-2017).
• Included patients with low-risk papillary thyroid cancer and solitary kidney masses eligible for nonoperative management per NCCN guidelines.
• Mixed-effects logistic regression modeled factors associated with nonoperative management, with hospital-level random effects.

Main Results:

• 19,570 patients with low-risk thyroid cancer and 41,403 with kidney cancer were analyzed.
• Nonoperative management rates varied significantly between hospitals for both cancer types (e.g., thyroid cancer: 1.1% to 10.3%; kidney cancer: 4.3% to 24.6%).
• Older age was associated with increased odds of nonoperative treatment for both cancers; hospital-level odds were minimally correlated between the two cancer types.

Conclusions:

• Significant hospital-level variability exists in the nonoperative management of low-risk thyroid and kidney cancers.
• While health system factors may play a role, hospital-specific drivers for nonoperative management appear distinct for different cancer types.
• Further research is needed to elucidate the precise mechanisms driving these inter-hospital differences in conservative cancer care.