Background: Prevalence of patients with end-stage renal disease (ESRD) receiving dialysis has continued to increase over the year and such patients may increasingly require chemotherapy on diagnosis of malignancy. ESRD as a significant medical comorbidity may deter medical oncologists from offering chemotherapy. Furthermore, a consensus on the dosage and timing of chemotherapy administration has not been established due to a paucity of data. We described the pattern of care for cancer patients on dialysis in our institution.
Methods: The dataset from Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) of dialysis-dependent patients who had a diagnosis of cancer was obtained and matched to the electronic records in Medical Oncology, The Canberra Hospital to identify patients who had a consultation to discuss chemotherapy. A manual search of correspondence over the same time period was also conducted to identify patients who had received chemotherapy while receiving dialysis. Clinical records of these patients were reviewed to extract relevant information relating to patient characteristics, details of the dialysis regimen and the details of chemotherapy administration, in particular the timing relating to dialysis and dose adjustment or delay.
Results: 21 dialysis-dependent patients were identified to have a cancer diagnosis from July 1999 to July 2014. Ten patients were referred to discuss chemotherapy, eight were offered chemotherapy, and five (23.8%) received chemotherapy. Most cycles administered were given immediately prior to dialysis. One patient discontinued treatment due to adverse events; the rest tolerated the planned treatment well. Two patients required either dose reduction or delay due to adverse events.
Conclusion: Chemotherapy administration is feasible in dialysis-dependent cancer patients. Chemotherapy receipt remained low in our institution but is consistent with that reported in the literature. A better understanding of the pharmacokinetics of chemotherapeutic agents will facilitate an improvement in chemotherapy practice for these patients in the future.