Chemotherapy in cancer patients undergoing hemodialysis: A multicenter study

Abstract

Background: Cancer is a major cause of death among patients undergoing hemodialysis (HD). However, little is known about the actual clinical practice of chemotherapy in cancer patients undergoing HD. Therefore, we conducted a nationwide questionnaire survey on chemotherapy for HD patients with cancer. Methods: This retrospective study included patients undergoing HD who were subsequently diagnosed with cancer from January 2010 to December 2012. We reviewed the clinical courses of the patients who underwent chemotherapy. The questionnaires that were sent to 20 institutions, members of the Onconephrology Consortium, consisted of the following sections: (1) patient characteristics; (2) regimen, dosing, and timing of chemotherapy; and (3) outcome. Results: Overall, 675 patients were registered and the most frequent primary cancer sites were kidney, colorectum, stomach, lung, bladder, liver, breast, and pancreas. Of these patients, 74 received chemotherapy (44 as palliative chemotherapy, 30 as perioperative chemotherapy). The primary causes of renal failure were chronic glomerulonephritis (23 patients) and diabetic nephropathy (17 patients). The most commonly used cytotoxic drugs were fluoropyrimidine (15 patients) and platinum (eight patients), and the dosing and timing of these drugs differed between institutions; however, the dosing of molecular targeting drugs (24 patients) and hormone therapy drugs (15 patients) was consistent. The median survival time of patients undergoing palliative chemotherapy was 13.0 months (0.1-60.3 months). Of these, three patients (6.8%) died from treatment-related causes and eight patients (18%) died of causes other than cancer. A high proportion of the patients who had diabetic nephropathy died of causes other than cancer including two treatment-related causes. Of 30 patients who received perioperative chemotherapy, six (20%) died of causes other than cancer within three years after the initiation of chemotherapy. Conclusions: Among HD patients with cancer who received chemotherapy, the rates of mortality from causes other than cancer might be high for both palliative and perioperative chemotherapy. The indications for chemotherapy in HD patients, particularly those with diabetes, should be carefully considered.