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  • br Discussion Due to the

    2019-08-16


    Discussion Due to the lack of current publicly available interactive web-tools for communicating risk, there is very little literature on the efficacy of web-based interactive graphics on the improvement in the understanding of risk [27]. Therefore, due to the lack of qualitative studies that address this, it Talaporfin sodium (ME2906) is uncertain whether making such tools available for the public improves the understanding of various cancer survival measures. However, we have informally evaluated InterPreT Cancer Survival’s impact on improving the understanding of a variety of cancer survival statistics by consulting a panel of patients via the Cancer Research UK patient sounding board (see Section 4.1). It has also been user-tested by a number of epidemiologists and clinicians. Generally, feedback from these users indicated that InterPreT Cancer Survival succeeded as an educational tool that could primarily be used to aid interpretation, or as supplemental material to help others distinguish between various cancer survival measures. Furthermore, the components and language incorporated into the web-tool have all been shown in previous studies to contribute to the improvement in the understanding and interpretation of information presented as probabilities [[7], [8], [9]]. The problem of what to present and communicate to patients is paradoxical in nature due to the awkwardness in interpretation of prognostic-relevant measures on the survival scale. Hagerty et al. [28] reviewed literature specifically in relation to the communication of patient prognosis in the context of cancer care. It was found that, patients in the early stages of their cancer welcomed detailed information on their prognosis which are publicly available. However, impact of prognosis communication is unclear for patients with advanced cancers, since prognosis in such cases are not so openly discussed. Therefore, the appropriate communication of prognosis in such cases was not obvious and requires further evaluation.
    Author contribution
    Financial support
    Conflict of interest
    Availability The online interactive cancer survival prediction tool, InterPreT, can be accessed via http://interpret.le.ac.uk. The web tool is compatible with most web browsers excluding Internet Explorer (e.g. Chrome, Firefox, Edge and Safari). We highly encourage readers to use the tool whilst reading the paper.
    Acknowledgments The authors are grateful to CRUK for granting access to the patient sounding board and contributing feedback on InterPreT’s user-interface.
    Introduction Historical data confirmed the feasibility of partial nephrectomy (PN) in patients with metastatic renal cell carcinoma (mRCC) [[1], [2], [3], [4]]. Moreover, it has been firmly and repeatedly demonstrated that PN with its nephron preservation effect exerts a beneficial role on other-cause mortality [[5], [6], [7], [8]] and other cancer-unrelated endpoints [[9], [10], [11]], in patients with non-metastatic RCC. However, a potential beneficial effect of PN on OCM has never been tested in patients with mRCC. Additionally, to the best of our knowledge, no studies compared early postoperative PN outcomes relative to radical nephrectomy (RN) in the context of mRCC, with the goal of examining the safety and feasibility of PN in mRCC patients.
    Materials and methods
    Results
    Discussion Cytoreductive nephrectomy is associated with survival benefit in select mRCC patients [[23], [24], [25]]. When focusing on nephrectomy types, several historical retrospective studies showed that PN does not undermine cancer control in the context of mRCC [[1], [2], [3], [4]]. The role of nephron-sparing surgery in preventing OCM and other complications that are unrelated to cancer has been shown in the context of non-metastatic RCC [5,6,[8], [9], [10]]. However, data confirming such beneficial role of PN on OCM in the metastatic setting are lacking. Additionally, none of these previous studies focused on the impact of PN on early postoperative outcomes in mRCC patients. Based on this premise, we relied on the most contemporary population-based cohort from within the SEER database to test the effect of PN on CSM and OCM, compared to RN in the context of mRCC. Additionally, we also tested the effect of PN on early postoperative complications, on in-hospital mortality and on LOS in a different database, namely the NIS. Our analyses revealed several noteworthy findings.