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)
Orientate you to this graph
We can see that for a patient surving 5 years on dialysis
just under 10% will be diagnosed with a non skin cancer (green)
this risk rises steadily with time

3. Cumulative risk of diagnosis of cancer post transplantation
Patients at Risk (8,881)
For transplant recipients ( cadaveric donor)
risk is somewhat higher,
with

4. Australia 2002 6812 people on dialysis 1079 dialysis deaths
63 (5.8%) deaths attributed to cancer
Greater number, but smaller proportion of patients on dialysis died of their cancer
smaller number, but greater proportion of patients with transplant diesd of their cancer.

5. Australia 2002 6812 people on dialysis 1079 dialysis deaths
63 (5.8%) deaths attributed to cancer
922 (13.5%) alive with a diagnosis of cancer
Greater number, but smaller proportion of patients on dialysis died of their cancer
smaller number, but greater proportion of patients with transplant diesd of their cancer.

6. Australia 2002 6812 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
Greater number, but smaller proportion of patients on dialysis died of their cancer
smaller number, but greater proportion of patients with transplant diesd of their cancer.

7. Australia 2002 6812 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
Greater number, but smaller proportion of patients on dialysis died of their cancer
smaller number, but greater proportion of patients with transplant diesd of their cancer.

8. Common cancers

9. Common cancers

10. Common cancers

11. Common cancers

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

13. All non - skin cancers
 age matched SA population  per 1000

14. Survival: all cancers Pre-ESRF Post transplant Dialysis ORIENTATE
mean age RR
Survival
For all cancer types survival is worse for patients on dialysis compared to those transplanted
Pts diagnosed pre ESRF are a highly selected population.
As you would expect of long term survivors, their death rate is constant with time , total N 1549
mortality steady at 4% per annum
For both dialysis and pos trnasplant populations the grwtrest attrition rates are in the first 2 years
The overall relative risk of a cancer in dialysis population compared to a normal age matched south australian population is 1.4.
median mortalityfor the dialysis population is 0.86/year +just over 10 months
The overall relative risk of a cancer in dialysis population compared to a normal age matched south australian population is 3.1
post trnasplant population = 2.23 yrs, 2 years 3 months

15. Cause of death of cancer patients
Cause of death of patients with a cancer diagnosis
listed for only 70% patients…… currently exploring the reasons……..
Greater proportion of dialysis patients have missing causes of death.
More likely to be listed as causing death for tx pts. Cardiac +social less likely
vascular and other relatively steady

16. Colon cancer
 age matched SA population  per 1000

17. Survival: colon cancer
Pre-ESRF
Post transplant
Dialysis
Some cancers seem to have uniformly poor survival
numbers
pre esrf 150
on dialysis 72
post Tx 93

18. Attributed cause of death

19. Attributed cause of death

20. Lung cancer
 age matched SA population  per 1000

21. Survival: lung cancer Pre-ESRF Dialysis Post transplant Pre esrf 23
on dialysis 155
post tx 103
Post transplant

22. Attributed cause of death

23. Attributed cause of death

24. Melanoma
 age matched SA population  per 1000

25. Survival: melanoma Pre-ESRF Post transplant Dialysis Pre esrf 99
on dialysis 64
post tx 175
mortality in the first year equal, and then we see separation

26. Attributed cause of death

27. Attributed cause of death

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