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Kidney Week

Abstract: FR-PO530

Nephrologists’ Perspectives on Cancer Screening in Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • James, Laura J, The University of Sydney, Westmead, New South Wales, Australia
  • Wong, Germaine, None, Auambie, New South Wales, Australia
  • Craig, Jonathan C., University of Sydney/Children's Hospital, Sydney, New South Wales, Australia
  • Tong, Allison, The University of Sydney, Sydney, New South Wales, Australia
Background

Cancer is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). However, cancer screening practices are highly variable among nephrologists, which may reflect uncertainties around the benefits and harms of screening in this setting, and the competing risk of death from other causes. Therefore we aimed to describe nephrologists’ perspectives on cancer screening and understand the factors impacting their practice.

Methods

Semi-structured interviews were conducted with 21 nephrologists from 11 centres across Australia and New Zealand. Transcripts were analysed thematically

Results

Five themes were identified: empowering patients to make informed decisions (respecting patient preferences, communicating evidence-based recommendations, creating awareness of consequences, preparing patients for transplantation); justifiable risk taking (avoiding undue consequences in vulnerable populations, ensuring cost effectiveness, warranted by long term immunosuppression, assurance of reasonable survival gains); prioritising current or imminent complications; ambiguity of evidence in supporting decisions (absence of standardised recommendations, limited transferability of population-based data); and depending on a shared multidisciplinary approach (collaboration with primary health care, wary of inadequate dermatological services, generating targeted cancer preventative services).

Conclusion

Nephrologists approach decisions about cancer screening in patients with CKD based on patient preferences, assessment of risk, justifiable survival gains, and current health priorities. Evidence-based guidelines and specialist clinics that address cancer screening may support shared decision making about cancer screening in CKD.

Funding

  • Government Support - Non-U.S.