In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.
Even though nearly all of these tumors turned out to be cancer, they rarely proved fatal. Surgery roughly doubled patients' risk of developing heart problems or dying of other causes.
After five years, 24 percent of those who had surgery had died, compared with only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.
The study only involved people 66 and older, but half of all kidney cancers occur in this age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.
The study also was observational — not an experiment where some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.
"I think it should change care" and older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center.
He led the study and will give results at a medical meeting in Orlando this week. The research was discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.
The results may help doctors persuade more patients to choose monitoring, said a cancer specialist with no role in the research, Dr. Bruce Roth of Washington University in St. Louis.