Burden of cancer in metastatic renal cell carcinoma (mRCC).

Abstract

467 Background: Combination regimens and sequencing of multiple agents have significantly improved clinical outcomes for patients (pts.) with mRCC. We sought to assess the burden of mRCC on patients and interference with daily life. Methods: The survey was developed by the Kidney Cancer Research Alliance (KCCure), and broadcast between 09/24 and 10/24 to pts. via website, mailing lists and social media platforms. Results: Of 1167 respondents, 492 pts. had received systemic therapy for mRCC. Median age was 58.7 years (range 17.2 - 87.0), 83% were from the United States. 42% were on first line treatment, 30% second line, 13% third line, and 15% in fourth or later line. 69% were on systemic on therapy with evidence of disease, 10% were receiving treatment with no evidence of disease, 13% had discontinued treatment with no evidence of disease; 8% had discontinued treatment with evidence of metastatic disease. 45% of pts. take ≥7 prescriptions per day, 11% take ≥10 prescription medications per day. One-third (33%) of pts. are concerned they are taking too many medications. In the last year, pts reported seeing 4.24 (range 1-17) different types of doctors for cancer related care. In the last 90 days: 36% have gone to the emergency room, 20% more than once. 96% had blood drawn at least once, 35% had ≥5 blood draws. 95% had at least one clinic visit, 22% ≥5 clinic visits. 30% had ≥5 pharmacy visits. 23% have been hospitalized, 12% for ≥5 days. In the last year, 45% were hospitalized at least once, 52% more than once, 11% ≥5 times. Hospitalizations and visits to the emergency room were significantly correlated with a lower quality of life and higher NCCN distress score (p<.001). 89% of pts think about cancer every day; 44% spend a few to several hours per day thinking about cancer. When asked how confident they feel about making plans, 33% feel completely confident making plans 6 months from now, 21% one year and 10% two years from now. Pts. with no evidence of disease are significantly more likely to rank their QOL as excellent (19%) compared to pts. with evidence of disease (4%), independent of treatment. Pts. who have discontinued treatment and still have evidence of disease rank their QOL as poor (17%). Conclusions: Pts. living with mRCC are physically and mentally consumed with cancer and disease management. mRCC disrupts fundamental daily activities, including eating, sleeping, and socializing. Pts. must routinely engage with the healthcare system, extensively managing scheduled and unscheduled appointments with multiple providers. Nearly all contemplate their cancer daily. More research is needed to improve care and alleviate disease burden in mRCC. Disruption of daily and routine activities. Activities Impacted by Cancer Frequency - Always or Often Eating a meal 37% Sleeping 38% Engaging with Friends 31% Grocery Shopping 25% Attending an Event 31% Buying Clothes 18% Traveling 43%