Rationale
With 1200 new cases each year, renal cell carcinoma accounts for approximately 2% of all malignant tumours. The incidence is increasing gradually.
Increased incidence and awareness of renal cell carcinoma has led to a rising demand for patient care. Treatment is almost always of a multidisciplinary nature, but treatment options are limited. Moreover, there is uncertainty regarding which treatment modalities should be offered (surgery or immunotherapy) and what effects various treatment approaches may have.
Early detection using modern imaging techniques followed by adequate treatment substantially increases the chance of survival for patients with renal cell carcinoma. Appropriate patient selection can increase the success rate of systemic treatment. Appropriate selection of patients with advanced disease for treatment with surgery and immunotherapy is highly relevant, given the costs associated with these interventions.
These issues, the involvement of a wide range of disciplines, and the economic aspects necessitate the formation of a clear, uniform guideline, whereby less ambiguous counselling can be provided to patients.
The considerations mentioned above formed the rationale for developing a multidisciplinary evidence-based guideline for the management of renal cell carcinoma by the Association of Comprehensive Cancer Centres (Vereniging voor Integrale Kanker Centra, VIKC) and the Dutch Urological Association (Nederlandse Vereniging voor Urologie). The Dutch Institute for Healthcare Quality Improvement, Monitoring and Maintenance (Kwaliteitsinstituut voor de Gezondheidszorg CBO) provided methodological support.

Goal
This guideline is a document that contains recommendations to aid in daily practice. The guideline is based on the results of scientific research and subsequently expert opinion aimed at establishing good medical practice. What is presented is considered in general the best care for patients with renal cell carcinoma. The guideline provides recommendations for the diagnosis, treatment, maintenance, follow-up, counselling and support of adult men and women with renal cell carcinoma.
The guideline may be used when counselling patients. It is possible that the guideline may contribute to early detection and thereby improve survival in these patients. The guideline also offers an initial basis for developing transmural care or local protocols to promote implementation.

Target audience
This guideline is intended for care providers involved in the treatment of patients with renal cell carcinoma: general practitioners, urologists, medical oncologists, anaesthesiologists, radiation oncologists, radiologists, pathologists, nuclear medicine physicians, pharmacists, psychologists, oncology nurses, and consultants for integrated cancer centres. 

Description of problem and basis questions
The multidisciplinary committee that created the guideline formulated a number of basis questions related to problems that arise in daily practice regarding the diagnosis, treatment, and counselling of patients with renal cell carcinoma (see appendix 1).
The questions address incidence; pathogenesis; symptomatology and factors that may influence further treatment; options for diagnosis and treatment, their effectiveness, and influence of quality of life. Several chapters also contain what is currently advisable for the psychosocial care of patients with renal cell carcinoma. The basis questions form the foundation for the various chapters in this guideline. The guideline is not intended to be comprehensive. Some additional instructional chapters have been included.

Composition of the working group
To develop the guidelines, a multidisciplinary working group was formed that consisted of representatives of all relevant specialities involved in the diagnosis and treatment of renal cell carcinoma. The working group included members of medical and paramedical disciplines, epidemiologists, a representative from the patient association "Vereniging Waterloop" for people with bladder or kidney cancer, and colleagues from the Association of Comprehensive Cancer Centres and the Dutch Institute for Healthcare Quality Improvement, Monitoring and Maintenance (see appendix 3).
In creating the working group, consideration was given to the geographic distribution of the group members, the proportional representation of various concerned associations and authorities, as well as distribution among those with and without an academic background. Working group members acted independently with authorisation from their associations.

For further information on the:

• basis questions, see appendix 1.
• composition of the working group, see appendix 3.
• members of the working group, see appendix 4.
• methods of the working group, see appendix 5.
• scientific argumentation, see appendix 6.
• classification of support based on the level of evidence, see appendix 7.
• development of recommendations, see appendix 8.
• implementation and evaluation, see appendix 9.
• legal implications of the guideline, see appendix 10.
• revisions, see appendix 11.