# Sex differences in health-related quality of life after renal cell carcinoma surgery: a population-based study in Sweden

## TL;DR

Men report better quality of life than women six months after kidney cancer surgery, even after adjusting for health and socioeconomic factors.

## Contribution

This study identifies persistent sex differences in health-related quality of life after kidney cancer surgery in a large Swedish population.

## Key findings

- Men had significantly higher HRQoL scores than women in both FKSI-14 and FKSI-19 assessments.
- The difference remained after adjusting for clinical, demographic, and socioeconomic factors.
- Men reported fewer symptoms in physical, mental, emotional, and treatment-related domains.

## Abstract

To examine sex differences in health-related quality of life (HRQoL) among patients surgically treated for renal cell carcinoma (RCC) in Sweden, utilizing data from the National Swedish Kidney Cancer Register (NSKCR).

In this study of 4658 surgically treated RCC patients, data on HRQoL, clinical, demographic, and socioeconomic characteristics were retrieved from the NSKCR for patients undergoing surgical treatment between January 2016, and April 2024. HRQoL was measured using the 14- and 19-item versions of the Functional Assessment of Cancer Therapy – Kidney Symptom Index (FKSI-14/19) instrument six months after surgery. The association between sex and HRQoL was estimated using linear regression. Separate analyses were performed for the FKSI-14 and FKSI-19 total scores and underlying domains.

In total, 3086 (66.3%) men and 1572 (33.7%) women were included. After adjusting for clinical, demographic, and socioeconomic characteristics, male sex was significantly associated with higher HRQoL. Specifically, men had higher scores, indicating fewer symptoms, for physical and mental symptoms according to FKSI-14 (P < 0.001), and for physical (P < 0.001) and emotional (P < 0.001) disease-related symptoms, as well as treatment side effects (P < 0.022), according to FKSI-19. Total HRQoL was significantly higher in men, according to both the FKSI-14 (P < 0.001) and the FKSI-19 (P < 0.001).

HRQoL differed significantly between men and women six months after surgery, with men reporting higher HRQoL, even after accounting for clinical, demographic, and socioeconomic factors. Healthcare professionals should be aware of the risk of lower HRQoL among female patients.

Survival after a kidney cancer diagnosis has improved significantly in recent decades, meaning that the number of survivors is growing. To provide better support for patients’ well-being, it is important to understand what influences the quality of life after treatment. In this study, we investigated whether there are differences in health-related quality of life between men and women who have undergone surgery for renal cell carcinoma, the most common type of kidney cancer. We analysed data from over 4500 patients in Sweden, about one-third of whom were women. Our findings showed that men reported better health-related quality of life than women, even after considering differences in for example age, health and socioeconomic factors. Our results suggest that more personalized support may be needed, especially for women, to reduce the unjustified differences in health-related quality of life between women and men.