Timely Psychological, Nutritional, Exercise Referrals Improve Outcomes for Kidney Cancer Survivors

After delivering a kidney cancer diagnosis, clinicians can use the disclosure window to initiate referrals for psychological, nutritional, or exercise support without needing to provide those interventions themselves.1

Kidney cancer survivors who participated in prehabilitation or rehabilitation programs experienced consistent improvements in physical and psychological outcomes, according to a scoping review of 18 randomized trials, underscoring opportunities for clinicians to connect patients with supportive care.1

“It can be intimidating to think about these kinds of extra things, rehab, prehab, exercise, and psychological support,” said Logan Briggs, MD, a senior resident at Mayo Clinic Arizona, in an interview with HCPLive. “But it’s a lot easier than you think to quickly screen patients who may be particularly anxious or depressed about their diagnosis and give them a referral. You don’t need to be the one counseling them.”

According to Briggs, these brief conversations form a pivotal foundation for supporting improved outcomes in patients after a cancer diagnosis. When a clinician takes 30 seconds to provide key referrals, patients can take an active role in their care without additional effort from the clinician.1

The same principle applies to patients with physical limitations or nutritional concerns. “Patients who may be debilitated or have disability may need referral to physical therapy, while those who are underweight or overweight may also face challenges that affect optimal care,” he said.

The timing of these referrals may be especially important during diagnostic disclosure. In a questionnaire study of 460 patients treated in the oncology unit at the National Cancer Institute, 44% reported diagnosis discussions ≤ 10 minutes, while 53% reported discussions > 10 minutes. Patient satisfaction scores were significantly higher when discussions > 10 minutes. Satisfaction also increased when clinicians included treatment options during the discussion rather than excluding them.2

To better characterize the role of supportive care interventions in kidney cancer, Briggs and colleagues conducted a scoping review of 18 randomized controlled trials involving patients enrolled in prehabilitation or rehabilitation programs. Interventions included psychological support, exercise-based programs, and nutritional or pharmacologic components. Investigators assessed whether each intervention demonstrated statistically significant positive, negative, or neutral effects across outcomes of interest.1

The systematic search identified 2,774 unique participants, including 706 patients or survivors with kidney cancer. Of the 18 trials, 6 exclusively enrolled patients with kidney cancer, while the remaining 12 included kidney cancer survivors as a subset of a broader cancer population.1

Across 18 randomized trials, nearly 80% demonstrated statistically significant benefits.1

Psychological support, particularly mindfulness-based and therapist-led interventions, showed the most consistent benefit, with 9 of 10 trials demonstrating significant improvements in patient-reported outcomes. All 3 trials combining exercise and psychological support showed benefit. In 1 key study, exercise alone and cognitive behavioral therapy alone did not help, but the combination did.1

Level 1 evidence supports preoperative carbohydrate drinks before radical nephrectomy, with improvements in quality of life and reduced postoperative weight loss. Exercise interventions were most effective when they met criteria for therapeutic validity, which was strongly associated with positive outcomes (r = 0.75; P = .034).1

Notably, no trials evaluated caregiver outcomes or cost-effectiveness, and few included patients receiving contemporary immunotherapy, which are key gaps for future research.1

“You don't necessarily need to be the one counseling them or providing any type of mindfulness therapy. There are online resources listed in the paper that the patients can be referred to,” explained Briggs. “They don't even need to be referred to a social worker. I would just encourage, you know, to take that 30 seconds to recommend the patient, check out some of these resources, or to provide a referral.”

References

1. Briggs LG, Parke SC, Gill VS, et al. Exercise, nutrition, and psychological support for kidney cancer: a scoping review. BJU International. Published online January 18, 2026. doi:https://doi.org/10.1111/bju.70134

2. Figg WD, Smith EK, Price DK, et al. Disclosing a Diagnosis of Cancer: Where and How Does It Occur? Journal of Clinical Oncology. 2010;28(22):3630-3635. doi:https://doi.org/10.1200/jco.2009.24.6389