Chemotherapy in cancer patients undergoing haemodialysis: a nationwide study in Japan

Abstract

BackgroundCancer is a major cause of death in patients undergoing haemodialysis. However, information about the actual clinical practice of chemotherapy for patients with cancer undergoing haemodialysis is lacking. We conducted a nationwide survey using questionnaires on the clinical practice of chemotherapy for such patients.Patients and methodsThe nationwide survey included patients undergoing haemodialysis who were subsequently diagnosed with cancer in 20 hospitals in Japan from January 2010 to December 2012. We reviewed their clinical data, including cancer at the following primary sites: kidney, colorectum, stomach, lung, liver, bladder, pancreas and breast. The questionnaires consisted of the following subjects: (1) patient characteristics; (2) regimen, dosage and timing of chemotherapy; and (3) clinical outcome.ResultsOverall, 675 patients were registered and assessed for main primary cancer site involvement. Of 507 patients with primary site involvement, 74 patients (15%) received chemotherapy (44 as palliative chemotherapy and 30 as perioperative chemotherapy). The most commonly used cytotoxic drugs were fluoropyrimidine (15 patients), platinum (8 patients) and taxane (8 patients), and the dosage and timing of these drugs differed between institutions; however, the dosage of molecular targeted drugs (24 patients) and hormone therapy drugs (15 patients) was consistent. The median survival time of patients receiving palliative chemotherapy was 13.0 months (0.1–60.3 months). Three patients (6.8%) died from treatment-related causes and nine patients (20%) died of causes other than cancer. Of the 30 patients who received perioperative chemotherapy, 6 (20%) died of causes other than cancer within 3 years after the initiation of chemotherapy.ConclusionAmong the haemodialysis patients with cancer who received chemotherapy, the rates of mortality from causes other than cancer might be high for both palliative and perioperative chemotherapy. Indications for the use of chemotherapy in patients undergoing haemodialysis should be considered carefully.

Incidence, Risk, and Prognosis of Cancer in Patients on Chronic Hemodialysis

“…And these patients were less likely to survive when a complication occurred. As for chemotherapy, though it is not contraindicated in dialysis patients with cancer, its usage is considered low, with the rate of 28% in France [52], 24% in Australia [53], and 9% (for palliative purpose) in Japan [54]. In our HD patients, only one patient received chemotherapy.…”

Successful management of hyperammonemia with hemodialysis on day 2 during 5-fluorouracil treatment in a patient with gastric cancer: a case report with 5-fluorouracil metabolite analyses

“…Among patients with impaired renal function, 5FU can safely be administered without dose adjustments, as it is metabolized in the liver and not in the kidneys [9][10][11][12]. In a previous observational study, most cancer patients undergoing hemodialysis (HD) received 5FU without dose adjustments [13]. However, the elimination of α-fluoro-β-alanine (FBAL), a 5FU metabolite, is dependent on renal excretion [14].…”

Treatment of Gastric and Gastroesophageal Cancer Patients with Hemodialysis by CapeOX

“…This study reported the anticancer drugs prescribed and dosage adjustment in hemodialysis patients but did not mention the recommend dosages of the prescribed anticancer drugs. A nationwide survey of chemotherapy in cancer patients undergoing hemodialysis was also conducted in Japan (13). Among 107 patients with unresectable cancer, only 44 (41%) underwent chemotherapy, 36 (34%) received the best supportive care, and 27 (25%) underwent other therapies.…”