Sociodemographic barriers to receiving adjuvant systemic therapy after nephrectomy for renal cell carcinoma

It is unknown whether sociodemographic barriers affect the use of adjuvant systemic therapy after nephrectomy among eligible renal cell carcinoma patients.

Within Surveillance, Epidemiology, and End Results database, we identified renal cell carcinoma patients eligible for adjuvant systemic therapy after nephrectomy between 2018 and 2022. Multivariable logistic regression models assessed associations between age, marital status, race/ethnicity, and adjuvant systemic therapy use.

Of 6,497 eligible patients, 1,163 patients (17.9%) received adjuvant systemic therapy. Treatment rates were lower in patients aged ≥65 years (14.9% vs. 21.2%, odds ratio [OR] 0.60, 95% confidence interval [CI]: 0.52-0.68, P < 0.001), unmarried individuals (15.9% vs. 19.0%, OR 0.75, 95% CI: 0.65-0.87, P < 0.001), and non-Caucasian patients (16.3% vs. 18.7%, OR 0.75, 95% CI: 0.65-0.87, P < 0.001), even after multivariable adjustment for other patient and tumor characteristics. Combined assessment of these 3 sociodemographic characteristics demonstrated a stepwise decrease in treatment rates, that were lowest in ≥65-year-old unmarried non-Caucasians (10.4%, OR 0.29, 95% CI: 0.19-0.41, P < 0.001) and highest in <65-year-old married Caucasians (24.2%, reference).

Despite guideline endorsement, only a minority of eligible renal cell carcinoma patients receive adjuvant systemic therapy after nephrectomy. Older age, unmarried status, and non-Caucasian race/ethnicity were independently associated with lower adjuvant systemic therapy receipt. The combination of these established sociodemographic barriers identified the patient subgroup with the lowest likelihood of receiving adjuvant systemic therapy. Efforts aimed at reducing disparities and close gaps in the implementation of guideline-recommended adjuvant systemic therapy use should therefore focus on individuals with this sociodemographic profile.