Survival of End Stage Renal Failure Patients with Cancer

Transcription

1 Survival of End Stage Renal Failure Patients with Cancer Angela Webster Centre for Kidney Research, The Children s Hospital at Westmead Department of Renal Medicine, Westmead Hospital, NSW School of Public Health, University of Sydney

2 Cumulative risk of diagnosis of cancer after start of dialysis Patients at Risk (30,892) 100% 80% 60% Any Cancer Skin Non Skin 100% 80% 60% 40% 40% 20% 20% 0% Years Since Commencing Dialysis 0%

3 Cumulative risk of diagnosis of cancer post transplantation Patients at Risk (8,881) 100% 80% 60% 40% Any Cancer Skin Non Skin Age-Matched Gen. Pop 100% 80% 60% 40% 20% 20% 0% Years Post Transplant 0%

4 Australia people on dialysis 1079 dialysis deaths 63 (5.8%) deaths attributed to cancer

5 Australia people on dialysis 1079 dialysis deaths 63 (5.8%) deaths attributed to cancer 922 (13.5%) alive with a diagnosis of cancer

6 Australia people on dialysis 1079 dialysis deaths 63 (5.8%) deaths attributed to cancer 922 (13.5%) alive with a diagnosis of cancer 5466 people with a functioning transplant 149 deaths 37 (25%) deaths attributed to cancer

7 Australia people on dialysis 1079 dialysis deaths 63 (5.8%) deaths attributed to cancer 922 (13.5%) alive with a diagnosis of cancer 5466 people with a functioning transplant 149 deaths 37 (25%) deaths attributed to cancer 735 (13.4%) alive with a diagnosis of cancer

8 Common cancers Dialysis Cad Transplant LR Transplant RR N RR N RR N Kidney Bladder Ureter

9 Common cancers Dialysis Cad Transplant LR Transplant RR N RR N RR N Kidney Bladder Ureter Total at risk

10 Common cancers Dialysis Cad Transplant LR Transplant RR N RR N RR N Kidney Bladder Ureter NHL Endocrine Cervix Total at risk

11 Common cancers Dialysis Cad/LUR Transplant LR Transplant RR N RR N RR N Kidney Bladder Ureter NHL Endocrine Cervix Colon Lung Melanoma Breast

12 Common non-skin cancers Relative and absolute risks Analysis of survival Attributed cause of death

13 All non - skin cancers Dialysis Post transplantation Cad/LUR LR At risk Expected # Diagnosed Relative R Incidence N ESRF Absolute R # age matched SA population per 1000

14 Survival: all cancers age survival (95%CI) proportion survivng.6.4 Pre-ESRF Post transplant (9.5,11.0) (1.7, 2.8).2 Dialysis (0.7, 1.0) years from diagnosis to death

15 Cause of death of cancer patients Cause of Time of diagnosis death % Pre ESRF Dialysis Post Tx cancer cardiac vascular social infection other 3 2 4

16 Colon cancer Dialysis Post transplantation Cad/LUR LR Expected # Diagnosed RR Incidence N ESRF AR # age matched SA population per 1000

17 Survival: colon cancer proportion surviving Pre-ESRF Post transplant age survival (95%CI) (9.2,12.5) (0.2, 1.3).1 Dialysis (0.0, 1.1) years from diagnosis to death

18 Attributed cause of death T all pts T cancer pts T colon D all pts D cancer pts cancer cardiac vascular social infection other D colon 0% 20% 40% 60% 80% 100%

19 Attributed cause of death T all pts T cancer pts T colon D all pts D cancer pts cancer cardiac vascular social infection other D colon 0% 20% 40% 60% 80% 100%

20 Lung cancer Dialysis Post transplantation Cad/LUR LR Expected # Diagnosed RR Incidence N ESRF AR # age matched SA population per 1000

21 Survival: lung cancer age survival (95%CI) proportion surviving Dialysis Pre-ESRF (2.7, 7.5) (0.3, 0.5).2.1 Post transplant (0.2, 0.3) years from diagnosis to death

22 Attributed cause of death T all pts T cancer pts T colon T lung D all pts D cancer pts cancer cardiac vascular social infection other D colon D lung 0% 20% 40% 60% 80% 100%

23 Attributed cause of death T all pts T cancer pts T colon T lung D all pts D cancer pts cancer cardiac vascular social infection other D colon D lung 0% 20% 40% 60% 80% 100%

24 Melanoma Dialysis Post transplantation Cad/LUR LR Expected # Diagnosed RR Incidence N ESRF AR # age matched SA population per 1000

25 Survival: melanoma Pre-ESRF age survival (95%CI) proportion surviving Post transplant (9.1, 15.1) (4.2, 8.7).2.1 Dialysis (1.0, 3.3) years from diagnosis to death

26 Attributed cause of death T all pts T cancer pts T colon T lung T melanoma D all pts D cancer pts D colon cancer cardiac vascular social infection other D lung D melanoma 0% 20% 40% 60% 80% 100%

27 Attributed cause of death T all pts T cancer pts T colon T lung T melanoma D all pts D cancer pts D colon cancer cardiac vascular social infection other D lung D melanoma 0% 20% 40% 60% 80% 100%

28 Conclusions Common cancers in the general population are more common in the ESRF population For any cancer type, survival is worse for patients diagnosed whilst on dialysis than post transplantation Deaths from cancer are proportionally far greater post transplantation

29 Future directions Re-analysis of survival adjusting for confounders age duration of ESRF Comparison with general population Linkage of databases