Determining Clinical Practice Patterns for Follow-up after treatment for Renal Cell Carcinomaresults of aModified Delphi Panel

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

J Endourol

Abstract

Introduction and Objective: Several guidelines exist to aid providers in their follow-up after treatment for renal cell carcinoma (RCC). Previous studies show varying adherence to these guidelines. We aimed to understand how providers in the Michigan Urological Surgery Improvement Collaborative (MUSIC) provide follow-up after RCC treatment, how this aligns with existing guidelines, and whether a modified Delphi methodology could help establish consensus in follow up practices to improve state-wide patient outcomes. Methods: A modified Delphi panel was used to gather information about post-operative follow-up patterns after RCC surgery. Using the AUA risk categories, the survey focused on understanding types of labs and imaging used at each follow-up as well as frequency and duration of follow-up. A consensus panel of MUSIC-affiliated urologists who routinely manage renal masses was formed. Areas of consensus (defined as >80% agreement) were established iteratively via 3 rounds of online questionnaires. Questions that achieved consensus were dropped out of subsequent rounds and those that did not achieve consensus were modified based on survey comments and asked again. Results: Thirty-three MUSIC urologists formed the panel. Our response rate in the second and third round was 97% (32/33) and 94% (31/33) respectively. Consensus was achieved in 37/74 (50%) areas administered through 242 questions. For very high risk and high risk patients, there was consensus on obtaining 2 labs, chest and abdominal imaging in the first two years of follow-up. For intermediate risk patients, there was consensus on obtaining 2 chest and abdominal imaging in the first year and labs once per year in years 3 to 5. For low risk patients, consensus was achieved on obtaining labs and abdominal imaging at least twice in the first year of follow-up, and once per year in years 2 to 5. However, consensus for 2 chest imaging was per year in year 1, and once per year in years 4 and 5 of follow-up. Conclusions: Regardless of the patient's risk category, there was consensus on doing testing every 6-12 months in the first 2 years of follow-up. However, the follow-up cadence for years 2-5 varied between the risk categories. Despite using AUA categories to formulate questions, results indicate that providers use a hybrid of the AUA and NCCN guidelines for follow-up with their post-treatment RCC patients.

Volume

39

Issue

S3

First Page

e50

Last Page

e51

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