The incidence of cancer recurrence and new cancer following commencement of dialysis

Abstract

Background Patients with kidney failure have a higher cancer risk compared to the age-matched general population. However, the outcomes of incident dialysis patients with a prior cancer history are unknown. Methods Using Australia and New Zealand Dialysis and Transplant Registry data (2000-2019), the outcomes and survival probabilities of incident dialysis patients with prior cancers and have experienced a cancer recurrence or have developed a new cancer after dialysis commencement were described. Results Of 4912 patients with prior cancers before dialysis commencement, 323 (7%) and 343 (7%) patients experienced cancer recurrence or developed new cancers post-dialysis initiation, respectively. The median (IQR) time from dialysis commencement to cancer recurrence was 1.2 (0.5-2.8) years, and was 2.0 (0.7-4.0) years for new cancer occurence. Of those with cancer recurrence, 80% presented with metastatic disease and 1 in 2 patients died from cancer, with a median time from cancer recurrence to death of 0.5 (0.2-1.7) years. Of those who developed new cancer, urinary tract and respiratory cancers were the most frequent cancer types, with a median time from new cancer diagnosis to death of 1.3 (0.4-3.1) years. The 3-year survival probabilities on dialysis following cancer recurrence and new cancer were 19% (95%CI 15%,24%) and 41% (35%,47%), respectively. Conclusion Among incident dialysis patients with a prior cancer history, 14% experienced cancer recurrence or developed a new cancer. Patients who experienced cancer recurrence or developed new cancer have poor outcomes, with less than 50% surviving beyond 3-years. These findings suggest the need to have a greater understanding of the characteristics, cancer screening, treatment responses and reasons for commencing dialysis in patients with kidney failure and prior cancer history, which may help in the shared clinical decision-making process when considering dialysis for these patients.