Risk Prediction Models for Kidney Cancer: A Systematic Review

Context Early detection of kidney cancer improves survival; however, low prevalence means that population-wide screening may be inefficient. Stratifying the population into risk categories could allow for the introduction of a screening program tailored to individuals. Objective This review will identify and compare published models that predict the risk of developing kidney cancer in the general population. Evidence Acquisition A search identified primary research reporting or validating models predicting the risk of kidney cancer in Medline and EMBASE. After screening identified studies for inclusion, we extracted data onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool. Evidence Synthesis The search identified 15,281 articles. Sixty-two satisfied the inclusion criteria; performance measures were provided for 11 models. Some models predicted the risk of prevalent undiagnosed disease and others future incident disease. Six of the models had been validated, two using external populations. The most commonly included risk factors were age, smoking status and BMI. Most of the models had acceptable-to-good discrimination (AUROC>0.7) in development and validation. Many also had high specificity; however, several had low sensitivity. The highest performance was seen for the models using only biomarkers to detect kidney cancer; however, these were developed and validated in small case-control studies. Conclusion We identified a small number of risk models that could be used to stratify the population according to risk of kidney cancer. Most exhibit reasonable discrimination but few have been externally validated in population-based studies. Patient Summary In this review, we looked at mathematical models predicting the likelihood of an individual developing kidney cancer. We found several suitable models, using a range of risk factors (such as age and smoking) to predict individual risk. Most of the models identified require further testing in the general population to confirm their usefulness.NIHR - RM-SR-2017-09-009 CRUK - C55650/A2146

Public attitudes towards screening for kidney cancer: an online survey

Funder: Kidney Cancer UKFunder: The Urology FoundationAbstract: Background: Kidney cancer is often asymptomatic, leading to proposals for a screening programme. The views of the public towards introducing a new screening programme for kidney cancer are unknown. The aim of this study was to explore attitudes towards kidney cancer screening and factors influencing intention to attend a future screening programme. Methods: We conducted an online population-based survey of 1021 adults aged 45–77 years. The main outcome measure was intention to attend four possible screening tests (urine, blood, ultrasound scan, low-dose CT) as well as extended low-dose CT scans within lung cancer screening programmes. We used multivariable regression to examine the association between intention and each screening test. Results: Most participants stated that they would be ‘very likely’ or ‘likely’ to undergo each of the screening tests [urine test: n = 961 (94.1%); blood test: n = 922 (90.3%); ultrasound: n = 914 (89.5%); low-dose CT: n = 804 (78.8%); lung CT: n = 962 (95.2%)]. Greater intention to attend was associated with higher general cancer worry and less perceived burden/inconvenience about the screening tests. Less worry about the screening test was also associated with higher intention to attend, but only in those with low general cancer worry (cancer worry scale ≤ 5). Compared with intention to take up screening with a urine test, participants were half as likely to report that they intended to undergo blood [OR 0.56 (0.43–0.73)] or ultrasound [OR 0.50 (0.38–0.67)] testing, and half as likely again to report that they intended to take part in a screening programme featuring a low dose CT scan for kidney cancer screening alone [OR 0.19 (0.14–0.27)]. Conclusion: Participants in this study expressed high levels of intention to accept an invitation to screening for kidney cancer, both within a kidney cancer specific screening programme and in conjunction with lung cancer screening. The choice of screening test is likely to influence uptake. Together these findings support on-going research into kidney cancer screening tests and the potential for combining kidney cancer screening with existing or new screening programmes

Home health monitoring around the time of surgery: a qualitative study of patients’ experiences before and after joint replacement

Objectives: Hip and knee replacements are common major elective surgical interventions with over 200,000 performed annually in the UK. Not all patients achieve optimal outcomes or experience problems or delays in recovery. The number of patients needing these operations are set to increase and routine clinical monitoring is time and resource consuming for patients and healthcare providers, therefore innovative evaluation of surgical outcomes are needed. The aim of this qualitative study was to capture the patient experience of living with a novel home monitoring sensing system during the period around joint replacement. Setting: One secondary care hospital in the South West, UK Participants: 13 patients, (8 female, 63-89y) undergoing total hip or knee replacement enrolled into the study Design: Qualitative study with thematic analysis. The system remained in situ for up to 12 weeks after their surgery and comprised a group of low powered sensors monitoring the environment (temperature, light and humidity) and activity of people within the home. Patients were interviewed at two timepoints: before and after surgery. Interviews explored views about living with the technology, its acceptability as well as attitudes towards health technology. Results: Three main themes emerged: installation of home sensing technology on the journey to surgery; the home space and defining unobtrusiveness and pivotal role of social support networks Conclusions: Patients who agreed to the technology found living with it acceptable. A home sensing system that monitors the environment and activity of the people in the home could provide an innovative way of assessing patients’ surgical outcomes. At a time, characterised by reduced mobility, functional limitations and increased pain, patients in this study relied on informal and formal supportive networks to help maintain the system through the busy trajectory of the perioperative period. Strengths and limitations of this study • In-depth one-to-one interviews provided insight into patients’ real experiences and views as they lived with the technology in their own homes • Although the sample size was small, lacked ethnic diversity and only included people willing to have technology installed in their homes, there was good diversity in age and gender and some diversity in patients undergoing hip and knee replacement • Use of thematic analysis enabled robust analysis of data, including focus on the acceptability of the technology in real health-related circumstances

Accuracy of blood pressure monitors owned by patients with hypertension (ACCU-RATE study)

Background Home blood pressure (BP) monitoring is recommended in guidelines and increasingly popular with patients and health care professionals, but the accuracy of patients’ own monitors in real world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and investigate factors affecting accuracy. Design and Setting Patients on the hypertension register at seven practices in central England were surveyed to ascertain if they owned a monitor and wanted it tested. Method Monitor accuracy was compared to a calibrated reference device, at 50 mmHg intervals between 0-280/300 mmHg (static pressure test), with a difference from the reference monitor of +/-3 mmHg at any interval considered a failure. Cuff performance was also assessed. Results were analysed by usage rates, length of time in service, make and model, monitor validation status, cost, and any previous testing. Results 251 (76%, 95% CI 71-80%) of 331 tested devices passed all tests (monitors and cuffs) and 86% passed the static pressure test, deficiencies primarily due to overestimation. 40% of testable monitors were unvalidated. Pass rate on the static pressure test was greater in validated monitors (96% [95% CI 94-98%] vs 64% [95% CI 58-69%]), those retailing for over £10, and those in use for less than four years.12% of cuffs failed. Conclusion Patients’ own BP monitor failure rate was similar to that in studies performed in professional settings, though cuff failure was more frequent. Clinicians can be confident of the accuracy of patients’ own BP monitors, if validated and less than five years old.This work represents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-1209-10051). The views expressed in this study are those of the authors and not necessarily of the NHS, the NIHR or the Department of Health. RJM was supported by an NIHR Professorship (NIHR-RP-02-12-015) and by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust. FDRH is part funded as Director of the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR), Theme Leader of the NIHR Oxford Biomedical Research Centre (BRC), and Director of the NIHR CLAHRC Oxford. JM is an NIHR Senior Investigator. No funding for this study was received from any monitor manufacturer

Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): a cross-sectional, observational study in central England.

BACKGROUND: Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known. AIM: To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. DESIGN AND SETTING: Cross-sectional, observational study in urban and suburban settings in central England. METHOD: Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. RESULTS: In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. CONCLUSION: Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old

Analysis of patient domestic activity in recovery from hip or knee replacement surgery: modelling wrist-worn wearable RSSI and accelerometer data in the wild

The UK health service sees around 160,000 total hip or knee replacements every year and this number is expected to rise. Expectations of surgical outcome are changing alongside demographic trends, whilst aftercare may be fractured as a result of resource limitation or other factors. Conventional assessments of health outcomes must evolve to keep up with these changing trends. In practice, patients may visit a health care professional to discuss recovery and will provide survey feedback to clinicians using standardised instruments, such as the Oxford Hip & Knee score, in the months following surgery. To aid clinicians in providing accurate assessment of patient recovery a continuous home health care monitoring system would be beneficial. In this paper the authors explore how the SPHERE sensor network can be used to automatically generate measures of recovery from arthroplasty to facilitate continuous monitoring of behaviour, including location, room transitions, movement and activity; in terms of frequency and duration; in a domestic environment. The authors present a case study of data collected from a home equipped with the SPHERE sensor network. Machine learning algorithms are applied to a week of continuous observational data to generate insights into the domestic routine of the occupant. Testing of models shows that location and activity are classified with 86% and 63% precision, respectively

Using home sensing technology to assess outcome and recovery after joint replacement – findings from the hip and knee study of a sensor platform of healthcare in a residential environment

Purpose: Improving outcomes after joint replacement is a key research priority. After joint replacement, up to 30% of patients report minimal improvement or their symptoms get worse and not all patients are satisfied with their outcome. Poor outcomes include continuing pain, functional limitation and increased healthcare utilisation. Patient Reported Outcome Measures (PROMs) such as the Oxford Hip or Oxford Knee Score and the EQ-5D, a measure of health status, are widely used to assess outcome after joint replacement in practice and research. These measures can assess a variety of health outcomes including pain, function and health related quality of life. Though widely used, many PROMs have methodological limitations and there is debate about how to interpret results and definitions of clinically meaningful change. Previously, research has explored the relationship between PROMs and objective measures, such as timed walks or sit-to-stand tests. Such objective measures are administered in controlled, laboratory style settings, and may not reflect levels of activity in daily life. With the rapid development of monitoring technology, there is opportunity to characterise the relationship between PROMs and behaviour in a natural setting and to develop methods of passive monitoring of outcome and recovery after surgery. We are working with a multidisciplinary team which has developed a system of low powered sensors that can monitor the health-related behaviours of people living at home. The system includes: sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage) a wrist-band body-worn activity monitor and silhouette (body outline) sensors. The SPHERE system of sensors is now being installed in 100 homes belonging to the general population. Within this cohort we are installing the system in the homes of 20 patients who are about to undergo a total hip or knee replacement (THR/TKR). The study aims to: (a) determine to what extent the sensory data obtained from the SPHERE system is comparable to data obtained from routine clinical measures and PROMs in the assessment of patients' activity, function and recovery processes; (b) investigate whether the sensory data can detect meaningful changes in recovery. Methods: To assess the accuracy and usefulness of the sensory data, in this 1-year observational study, patients will be provided with the sensor system to monitor and record daily continuous measurements. We will make and refine appropriate data learning outcomes with the quantitative data e.g., daily measurements in the weeks parallel to the distribution of PROM assessments pre/post-operative (4–9 days, 6 and 12 weeks) and weekly measurements during the other months. The study will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the PROMs assessments over time. Interviews and focus groups with patients and health professional will provide qualitative data and achieve depth in understanding the accuracy of the data, its usefulness for health professionals in decision making, and if the technology is acceptable. Results: The SPHERE sensor system has been installed in the homes of two patients. We aim to recruit up to 20 patients, (aged 18 years or over) whom are due to undergo a TKR or THR in the UK. Conclusions: This study will provide a unique understanding of home and wearable sensor technology in an orthopaedic population and will compare sensor data with current PROMs

Using home sensing technology to assess outcome and recovery after hip and knee replacement in the UK: the HEmiSPHERE study protocol

Abstract Introduction Over 160 000 people with severe hip or knee pain caused by osteoarthritis undergo total hip (THR) or knee replacement (TKR) surgery each year in the UK within the National Health Service (NHS), and this number is expected to increase. Innovative approaches to evaluating surgical outcomes will be needed to respond to the increasing burden of joint replacement surgery. The Sensor Platform for Healthcare in a Residential Environment, Interdisciplinary Research Collaboration (SPHERE-IRC) have developed a system of sensors that can monitor the health-related behaviours of people living at home. The system includes sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage), a wristband body-worn activity monitor and silhouette (body outline) sensors. The aim of HEmiSPHERE (Hip and knEe study of a Sensor Platform of HEalthcare in a Residential Environment) is to (1) determine the accuracy and feasibility of the sensory data as it compares with conventional assessment of health outcomes after surgery using patient self-reported questionnaires, and (2) to explore how the SPHERE system is useful for everyday clinical decision-making. Methods and analysis A feasibility study recruiting and installing the SPHERE system in the homes of up to 30 NHS adult patients as they undergo a THR or TKR. Through a mixed-methods design, the SPHERE system will monitor and record continuous measurements of daily behaviour. Main outcomes will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the standard clinical assessments measuring patient outcomes over time. Patient interviews and focus groups with consultant orthopaedic surgeons will provide in-depth understanding of the acceptability, feasibility and accuracy of the data. Ethics and dissemination We aim to disseminate the findings through regional talks and seminars, international conferences and peer-reviewed journals and social media