Dr Wang on the Role of Active Surveillance in Patients With Renal Masses

Katherine (Yuhzi) Wang, MD, a research fellow at Henry Ford Health, discusses the role of active surveillance for patients with renal masses and the ongoing MUSIC-KIDNEY project in Michigan.

MUSIC-KIDNEY is a statewide quality improvement project that is maintaining a database of patients with newly diagnosed renal masses and tracking which patients are treated with active surveillance compared with other treatments. Patients with smaller tumors, as well as those with a limited life expectancy or comorbidities, are usually good candidates for active surveillance. One of the objectives of MUSIC-KIDNEY was determining how many patients who were good candidates for active surveillance were receiving it in an appropriate manner, Wang explains.

At the data cutoff, MUSIC-KIDNEY had 3968 patients and approximately 80% of the patients who chose to receive active surveillance were determined to be good candidates for active surveillance by investigators, Wang says. Notably, approximately 30% of patients who received a treatment besides active surveillance were appropriate candidates for active surveillance, Wang notes.

However, active surveillance is not right for every patient and fitness for it cannot necessarily be determined by a model or a study, Wang notes. The choice of active surveillance is a major decision that should be shared by the clinician and the patient and there are several layers that play a role in this decision, Wang explains. For example, many patients do not want to go on active surveillance due to the anxiety that they experience knowing that they harbor cancer in their body, even in the event that it is slow growing or indolent. It’s understandable that a patient would want to undergo surgery or receive another treatment modality, Wang says. Overall, it is good to know that the appropriate patients are receiving active surveillance but that shouldn’t serve as the end of the discussion as there is much more nuance to this decision, Wang concludes.