Practice Patterns of Adjuvant Therapy among Patients with Unilateral Wilms Tumor: A Population-Based Analysis
Hriday Bhambhvani, B.S., Kunj Sheth, M.D..
Stanford University School of Medicine, Stanford, CA, USA.
BACKGROUND: Treatment guidelines support the use of adjuvant therapy, consisting of chemotherapy and/or radiotherapy (RT), following nephrectomy among patients with unilateral Wilms tumor (WT). Given the paucity of epidemiologic research in this realm, we sought to use a national database to examine practice patterns and factors associated with receipt of adjuvant therapy in this population.
METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 program database was queried to identify patients diagnosed with unilateral WT between 2000 and 2016. Multivariable logistic regression, adjusted for age, sex, race, laterality, stage, tumor size, insurance status, and socioeconomic status (SES), was used to identify factors associated with the receipt of chemotherapy and RT.
RESULTS: 2154 patients were included. Average age was 4.9 years. 1900 patients (88.2%) received chemotherapy and 981 (45.5%) received RT. The insurance status of 900 (41.8%) of patients was unknown, while 729 (33.8%) were privately insured, 503 (23.4%) had Medicaid, and 22 (1.0%) were uninsured. Increasing age was associated with reduced odds of chemotherapy (OR = 0.95, 95% CI = 0.94 - 0.97, p < 0.0001). Uninsured patients were less likely to receive chemotherapy (OR = 0.19, 95% CI = 0.07 - 0.54, p = 0.001) and RT (OR = 0.33, 95% CI = 0.11 - 0.99, p =0.05) as compared to insured patients. Regional and distant stages of disease were associated with increased likelihood of both chemotherapy and RT as compared to localized disease
CONCLUSIONS: Uninsured patients with unilateral WT were less likely to receive adjuvant therapy than insured patients.
Back to 2021 Abstracts