This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers. ELIGIBILITY CONCURRENT COMPONENTS OF SURVIVORSHIP VISIT Category 1 DISPOSITION ● Years 2 SURVEILLANCE Kidney Cancer after completion of treatment and NED1 (Patients with suspected or confirmed Von Hippel-Lindau disease are excluded from this algorithm) - 3-10: Physical exam with each visit BUN, creatinine, alkaline phosphatase, ALT, AST, LDH, Total bilirubin annually Chest X-ray annually CT of abdomen every 2 years CT of chest as clinically indicated ● Years 3 Category 2 5-10: - Physical exam with each visit - BUN, creatinine, alkaline phosphatase, ALT, AST, LDH, Total bilirubin annually - Chest X-ray annually - CT of chest and abdomen every 2 years ● Years 11-15: - Physical exam with each visit - BUN, creatinine, alkaline phosphatase, ALT, AST, LDH, Total bilirubin annually - Imaging studies as clinically indicated New primary or recurrent disease? Yes No Return to primary treating physician Continue survivorship visits MONITORING FOR LATE EFFECTS RISK REDUCTION/ EARLY DETECTION See Page 2 PSYCHOCOCIAL FUNCTIONING 1 NED = No Evidence of Disease Category 1: Pathologic T1a (tumor less than or equal to 4 cm) limited to kidney; transition to Survivorship at 3 years after completion of treatment and NED 3 Category 2: Pathologic T1b – T4; transition to Survivorship at 5 years after completion of treatment and NED 2 Copyright 2014 The University of Texas MD Anderson Cancer Center Department of Clinical Effectiveness V4 Approved by the Executive Committee of the Medical Staff 08/26/2014 This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers. ELIGIBILITY Kidney Cancer after completion of treatment and NED1 (Patients with suspected or confirmed Von Hippel-Lindau disease or ablative therapy as primary treatment are excluded from this algorithm) 1 2 CONCURRENT COMPONENTS OF SURVIVORSHIP VISIT DISPOSITION MONITORING FOR LATE EFFECTS Renal insufficiency RISK REDUCTION/ EARLY DETECTION Patient education/counseling/screening: ● Colorectal cancer screening (See Colorectal Cancer Screening Algorithm) 2 ● Prostate cancer screening for men ● Breast cancer screening for women (See Breast Cancer Screening Algorithm) ● Cervical cancer screening for women (See Gynecologic Cancer Screening Algorithm) ● Diet/weight management ● Exercise/activity ● Tobacco cessation ● Sun exposure/skin cancer screening if indicated PSYCHOCOCIAL FUNCTIONING Assess for: ● Distress ● Financial stressors Refer or consult as indicated Body image ● Social support ● NED = No Evidence of Disease Beginning at age 50 (45 for family history and/or African American) until age 75. Copyright 2014 The University of Texas MD Anderson Cancer Center Department of Clinical Effectiveness V4 Approved by the Executive Committee of the Medical Staff 08/26/2014 This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers. SUGGESTED READINGS Brookman-May, S., May, M., Shariat, S. F., et al. (2013). Features Associated with Recurrence Beyond 5 Years After Nephrectomy and Nephron-Sparing Surgery for Renal Cell Carcinoma: Development and Internal Validation of a Risk Model (PRELANE score) to Predict Late Recurrence Based on a Large Multicenter Database (CORONA/ SATURN Project). European Urology, 64(3), 472-477. Brookman-May, S., May, M., Shariat, S. F., et al. (2013). Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma – results from a comprehensive multi-centre database (CORONA/SATURN-Project). BJU International, 112(7), 909-916. Chae EJ, Kim JK, Kim SH, et al. (2005). Renal cell carcinoma: analysis of postoperative recurrence patterns. Radiology; 234(1): 189-196. Escudier B, & Kataja V. (2009). Renal cell carcinoma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Annals of Oncology; 20 (Supplement 4): iv81-iv82). Kattan MW, Reuter V, Motzer RJ, et al. (2001). A postoperative prognostic nomogram for renal cell carcinoma. The Journal of Urology; 166:63-67 Lam JS, Shvarts O, Leppert JT, et al. (2005). Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system. The Journal of Urology; 174: 466-72. Levy DA, Slaton JW, Swanson DA, & Dinney CP. (1998). Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. The Journal of Urology; 159: 1163-1167. Mickisch G, Carballido J, Hellsten S, et al. (2001). Guidelines on renal cell cancer. European Urology; 40: 252-255. Psutka A, Feldman AS, McDougal WS, et al. (2013). Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. European Urology, 63(3), 486-492. Shuch B, Pantuck AJ, & Klatte T. (2008). Surveillance for metastatic disease after nephrectomy for renal cell carcinoma. Up To Date. Stephenson AJ, Chetner MP, Rourke K, et al. (2004). Guidelines for the surveillance of localized renal cell carcinoma based on the patterns of relapse after nephrectomy. The Journal of Urology; 172: 58-62. The NCCN Clinical Practice Guidelines in Oncology Kidney Cancer (Version 3.2014). 2014 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed [June 12, 2014]. Copyright 2014 The University of Texas MD Anderson Cancer Center Department of Clinical Effectiveness V4 Approved by the Executive Committee of the Medical Staff 08/26/2014 This cancer survivorship algorithm has been specifically developed for MD Anderson using a multidisciplinary approach and taking into consideration circumstances particular to MD Anderson, including the following: MD Anderson’s specific patient population; MD Anderson’s services and structure; and MD Anderson’s clinical information. This algorithm is provided as informational purposes only and is not intended to replace the independent medical or professional judgment of physicians or other health care providers. DEVELOPMENT CREDITS This practice algorithm is based on literature review conducted by the Genitourinary Survivorship Committee, and majority expert opinion of the Genitourinary Center Faculty at The University of Texas MD Anderson Cancer Center. Core committee team members include: William Graber, MD Eric Jonasch, MD Jose A. Karam, MD Jeri Kim, MD Deborah A. Kuban, MD Surena Matin, MD William E. Osai, RN, APN, FNP Lance Pagliaro, MD Christopher Wood, MD Fran Zandstra, RN Department of Clinical Effectiveness V4 Approved by the Executive Committee of the Medical Staff 08/26/2014 Copyright 2014 The University of Texas MD Anderson Cancer Center