High Burden of In-Person Kidney Cancer Surveillance in a Low Resource Population

Postoperative kidney cancer surveillance is predominantly based on imaging and laboratory evaluation rather than physical exam. We sought to characterize the burden of kidney cancer surveillance in a low resource population with an aim to identify opportunities for telehealth implementation.

We retrospectively reviewed patients who underwent partial or radical nephrectomy between November, 2016 and May, 2018 at an academic medical center. We reviewed patient demographic characteristics, travel distance to hospital, and Center for Medicare & Medicaid Services designation of home ZIP code as low income area or health professional shortage area. Followup visits were reviewed for imaging and laboratory studies as well as new physical exam findings.

We identified 156 patients who attended 234 followup visits at mean 2.4 months (SD=2.9 months) postoperatively. Patient home ZIP codes were designated as low income area or health professional shortage area in 93 (59.6%) cases. One-way travel was mean 194 miles (SD=438 miles) per visit. When intended, laboratory or imaging studies were not obtained ahead of followup visits in 34 of 196 cases (17%). Based on the absence of new physical exam findings or procedures performed 201 (86%) visits could have potentially been performed remotely.

Patients living in low income areas and health professional shortage areas are asked to travel long distances to perform kidney cancer surveillance often to review data that could be obtained remotely. Necessary imaging or laboratory studies are frequently not obtained ahead of appointments, further diminishing visit value. Kidney cancer surveillance may offer a promising opportunity for telehealth implementation within urology.