Top

Supportive Care in Cancer

Published in:

01-06-2015 | Original Article

Hyponatremia as an independent prognostic factor in patients with terminal cancer

Authors: Johi Yoon, Seo Hee Ahn, Yong Joo Lee, Chul-Min Kim

Published in: Supportive Care in Cancer | Issue 6/2015

Abstract

Purpose

Hyponatremia is a common and associated with poor clinical outcome in cancer patients. But little is known regarding hyponatremia in terminal cancer patients. The purpose of this study is to investigate the prognostic role of the hyponatremia in terminal cancer patients.

Methods

A retrospective observational study was conducted between January 2010 and December 2012 in a tertiary hospital palliative care unit. Medical records were collected from hospitalized patients who were eligible for obtaining serum sodium level. Hyponatremia was defined as serum sodium <136 mEq/L. And we classified patients into three groups; eunatremia (sodium 136–145 mEq/L), mild to moderate hyponatremia (sodium 126–135 mEq/L), and severe hyponatremia (sodium ≤125 mEq/L). Univariate and multivariate Cox regression analyses were performed to determine factors affecting survival time.

Results

Of the 576 patients, hyponatremia was present in 367 individuals (63.7 %). In the univariate analysis, serum CRP, PPS, and sodium ≤125 mEq/L were associated with survival time (HR = 1.22; p < 0.001, HR = 0.69; p < 0.001, HR = 1.91; p < 0.001). In the multivariate analysis, serum CRP, PPS, sodium 126–135 mEq/L, and sodium ≤125 mEq/L were associated with survival time (HR = 1.16; p < 0.001, HR = 0.70; p < 0.001, HR = 1.19; p = 0.048, HR = 1.75; p < 0.001).

Conclusions

Hyponatremia is an independent prognostic factor in terminal cancer patients and careful clinical concern is needed. In the future, large prospective study is warranted in terminal cancer patients.

Schrier RW (2006) Water and sodium retention in edematous disorders: Role of vasopressin and aldosterone. Am J Med 119:S47–S53. doi:10.1016/j.amjmed.2006.05.007 CrossRefPubMed

Upadhyay A, Jaber BL, Madias NE (2009) Epidemiology of hyponatremia. Semin Nephrol 29(3):227–238. doi:10.1016/j.semnephrol.2009.03.004 CrossRefPubMed

Waikar SS, Mount DB, Curhan GC (2009) Mortality after hospitalization with mild, moderate, and severe hyponatremia. Am J Med 122(9):857–865. doi:10.1016/j.amjmed.2009.01.027 CrossRefPubMedCentralPubMed

Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE (2010) Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med 170(3):294–302CrossRefPubMed

Zilberberg MD, Exuzides A, Spalding J, Foreman A, Jones AG, Colby C, Shorr AF (2008) Epidemiology, clinical and economic outcomes of admission hyponatremia among hospitalized patients. Curr Med Res Opin 24(6):1601–1608. doi:10.1185/03007990802081675 CrossRefPubMed

Doshi SM, Shah P, Lei XD, Lahoti A, Salahudeen AK (2012) Hyponatremia in hospitalized cancer patients and its impact on clinical outcomes. Am J Kidney Dis 59(2):222–228. doi:10.1053/j.ajkd.2011.08.029 CrossRefPubMed

Berghmans T, Paesmans M, Body JJ (2000) A prospective study on hyponatraemia in medical cancer patients: Epidemiology, aetiology and differential diagnosis. Support Care Cancer 8(3):192–197CrossRefPubMed

Raftopoulos H (2007) Diagnosis and management of hyponatremia in cancer patients. Support Care Cancer 15(12):1341–1347. doi:10.1007/s00520-007-0309-9 CrossRefPubMed

Sorensen JB, Andersen MK, Hansen HH (1995) Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in malignant disease. J Intern Med 238(2):97–110CrossRefPubMed

10.

Langfeldt LA, Cooley ME (2003) Syndrome of inappropriate antidiuretic hormone secretion in malignancy: Review and implications for nursing management. Clin J Oncol Nurs 7(4):425–430. doi:10.1188/03.CJON. 425-430 CrossRefPubMed

11.

Liamis G, Milionis H, Elisaf M (2008) A review of drug-induced hyponatremia. Am J Kidney Dis 52(1):144–153. doi:10.1053/j.ajkd.2008.03.004 CrossRefPubMed

12.

Castillo JJ, Vincent M, Justice E (2012) Diagnosis and management of hyponatremia in cancer patients. Oncologist 17(6):756–765. doi:10.1634/theoncologist.2011-0400 CrossRefPubMedCentralPubMed

13.

Hermes A, Waschki B, Reck M (2012) Hyponatremia as prognostic factor in small cell lung cancer—a retrospective single institution analysis. Respir Med 106(6):900–904. doi:10.1016/j.rmed.2012.02.010 CrossRefPubMed

14.

Hansen O, Sorensen P, Hansen KH (2010) The occurrence of hyponatremia in SCLC and the influence on prognosis a retrospective study of 453 patients treated in a single institution in a 10-year period. Lung Cancer 68(1):111–114. doi:10.1016/j.lungcan.2009.05.015 CrossRefPubMed

15.

Kawahara M, Fukuoka M, Saijo N, Nishiwaki Y, Ikegami H, Tamura T, Shimoyama M, Suemasu K, Furuse K (1997) Prognostic factors and prognostic staging system for small cell lung cancer. Jpn J Clin Oncol 27(3):158–165CrossRefPubMed

16.

Osterlind K, Andersen PK (1986) Prognostic factors in small cell lung cancer: multivariate model based on 778 patients treated with chemotherapy with or without irradiation. Cancer Res 46(8):4189–4194PubMed

17.

Jacot W, Colinet B, Bertrand D, Lacombe S, Bozonnat MC, Daures JP, Pujol JL, network Oh (2008) Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients. Ann Oncol 19(8):1458–1464. doi:10.1093/annonc/mdn064 CrossRefPubMed

18.

Jeppesen AN, Jensen HK, Donskov F, Marcussen N, von der Maase H (2010) Hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma. Brit J Cancer 102(5):867–872. doi:10.1038/sj.bjc.6605563 CrossRefPubMedCentralPubMed

19.

Gross P, Reimann D, Henschkowski J, Damian M (2001) Treatment of severe hyponatremia: Conventional and novel aspects. J Am Soc Nephrol 12(2):S10–S14PubMed

20.

Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, Czerwiec FS, Orlandi C (2006) Tolvaptan, a selective oral vasopressin V-2-receptor antagonist, for hyponatremia. New Engl J Med 355(20):2099–2112. doi:10.1056/Nejmoa065181 CrossRefPubMed

21.

Gheorghiade M, Niazi I, Ouyang J, Czerwiec F, Kambayashi J, Zampino M, Orlandi C, Tolvaptan I (2003) Vasopressin V2-receptor blockade with tolvaptan in patients with chronic heart failure: Results from a double-blind, randomized trial. Circulation 107(21):2690–2696. doi:10.1161/01.CIR.0000070422.41439.04 CrossRefPubMed

22.

Gerbes AL, Golberg V, Gines P, Decaux G, Gross P, Gandjini H, Djian J, Grp VS (2003) Therapy of hyponatremia in cirrhosis with a vasopressin receptor antagonist: a randomized double-blind multicenter trial. Gastroenterology 124(4):933–939. doi:10.1053/gast.2003.50143 CrossRefPubMed

23.

Saito T, Ishikawa SE, Abe K, Kamoi K, Yamada K, Shimizu K, Saruta T, Yoshida S (1997) Acute aquaresis by the nonpeptide arginine vasopressin (AVP) antagonist OPC-31260 improves hyponatremia in patients with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Clin Endocrinol Metab 82(4):1054–1057. doi:10.1210/Jc.82.4.1054 CrossRefPubMed

24.

Maltoni M, Caraceni A, Brunelli C, Broeckaert B, Christakis N, Eychmueller S, Glare P, Nabal M, Vigano A, Larkin P, De Conno F, Hanks G, Kaasa S (2005) Prognostic factors in advanced cancer patients: Evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23(25):6240–6248. doi:10.1200/Jco.2005.06.866 CrossRefPubMed

25.

Anderson F, Downing GM, Hill J, Casorso L, Lerch N (1996) Palliative performance scale (PPS): a new tool. J Palliat Care 12(1):5–11PubMed

26.

Seow H, Barbera L, Dudgeon D, Howell D, Husain A, Atzema C, Sussman J, Liu Y, Earle C, Sutradhar R (2013) The association of the palliative performance scale and hazard of death in an ambulatory cancer population. J Palliat Med 16(2):156–162. doi:10.1089/jpm.2012.0239 CrossRefPubMed

27.

Mahmoud FA, Rivera NI (2002) The role of C-reactive protein as a prognostic indicator in advanced cancer. Curr Oncol Rep 4(3):250–255CrossRefPubMed

Title: Hyponatremia as an independent prognostic factor in patients with terminal cancer
Authors: Johi Yoon
Seo Hee Ahn
Yong Joo Lee
Chul-Min Kim
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 6/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-014-2522-7

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2015

A prospectively validated nomogram for predicting the risk of chemotherapy-induced febrile neutropenia: a multicenter study

Caregiving among American Indians and Alaska Natives with cancer

Prognostic impact of cancer cachexia in patients with advanced non-small cell lung cancer

Minimally invasive palliative procedures in oncology: a review of a multidisciplinary collaboration

Cancer survivors’ perceived need for supportive care and their attitude towards self-management and eHealth

Adverse breast cancer treatment effects: the economic case for making rehabilitative programs standard of care

Keynote webinar | Spotlight on antibody–drug conjugates in cancer