SUN-208 Cost Analysis of Parathyroidectomy for Patients with Severe Uncontrolled Secondary Hyperparathyroidism at a Large Integrated Health Care Service in United Arab Emirates

Abstract

The risk of cancer among end stage renal disease patients is higher than general population. Types of malignancy, age of patients, comorbid condition and functional status can influence management of cancer. The data regarding cancer among hemodialysis patients in Middle East area is rarely reported. We aim to study the types of cancers in hemodialysis patients in a tertiary oncology center in United Arab Emirate. Methods: Ethical approval was obtained to conduct a retrospective chart review study at Tawam Hospital from January 2009 to August 2019. We included end stage renal disease adult patients (age >18) with diagnosis of cancer after initiation of hemodialysis. Laboratory data and Clinical outcomes were analyzed using descriptive analysis. Results: A total of 1708 patients required hemodialysis during study period and 203 patients had diagnosis of cancer. 68 hemodialysis patients fulfilled the inclusion criteria (cancer after initiation of HD). The mean age was 68.8 years, and male to female ratio (2:1). National patients were 32 (47%). The duration of hemodialysis prior to cancer diagnosis was ranging from 0.5 to 10 years. Majority of patients had arteriovenous fistula (48) as access for HD and 20 patients had tunneled HD catheters. The comorbid conditions in our cohort were hypertension (61 [89.7%]), diabetes mellitus (50 [73.5%]), ischemic heart disease (33 [48.5%]), stroke (13 [19.1%]) and peripheral vascular disease (14[ 20.5%]). The most common type of cancers was urogenital 18 (26.4%)(renal cell carcinoma (7), bladder cancer (6), prostate cancer(5)). Hematological malignancies were as the following multiple myeloma (6), leukemia (chronic myeloid CML (1), plasma cell leukemia (1)), and lymphoma (3). Breast cancer has been identified in 5 HD female patients while ovarian cancer andcervical cancer were identified in 1.4 %. Lung cancer was found only in two HD patients with positive smoking history. Gastrointestinal cancers diagnosed in our cohort were colon cancer (7), gastric (3), esophageal cancer (3), liver cancer (2) and pancreatic cancer (2). Skin cancers were identified in patient who failed renal transplant (Basal cell carcinoma and Squamous cell carcinoma). 23 patients (33.8%) had metastatic disease at time of diagnosis. 23 patients (33.8%) had metastatic disease at time of diagnosis. Majority of patient received chemotherapy (29 [42.6%]). Oncology surgery and radiotherapy were done in selected patients (33.8%). The mortality rate was high especially with metastatic disease andfew patients opted for palliative care. Conclusions: The incidence of cancer in our hemodialysis patients over 10 years is low with predominance of urogenital cancers. Patients with metastatic disease had poor prognosis and palliative care is essential.