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Comparison of Stage at Diagnosis of Cancer in Patients Who Are on Dialysis versus the General Population

Shilpa Taneja^*, Sreedhar Mandayam, Zainab Z. Kayani^*, Yong-Fang Kuo^*, and Vahakn B. Shahinian

^* Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Wichita Nephrology Group, Wichita, Kansas; and Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

Address correspondence to: Dr. Vahakn B. Shahinian, University of Michigan, Division of Nephrology, Department of Internal Medicine, 102 Observatory Road, 301 Simpson Memorial Institute, Ann Arbor, MI 48109-0725. Phone: 734-764-7502; Fax: 734-615-4887; E-mail: vahakn{at}umich.edu

Background and Objectives: Frequent medical encounters in patients with ESRD on dialysis may allow early detection of malignancies despite low rates of cancer screening in this population. It is therefore unclear whether dialysis patients are disadvantaged in terms of cancer diagnosis. This study compared stage at diagnosis of cancer in a population-based sample of patients with ESRD versus the general population.

Design, Setting, Participants, & Measurements: The Surveillance, Epidemiology, and End Results Medicare database was used to identify patients with ESRD and incident cancers from 1992 through 1999. Modified Poisson regression models were used to predict nonlocalized stage of cancer at diagnosis in patients with ESRD versus the general population, adjusting for demographics, cancer site, region, year of diagnosis, and comorbidity. Two general population comparisons were used: Standardized Surveillance, Epidemiology, and End Results public-use data and Medicare control subjects without ESRD matched 3:1 to patients with ESRD.

Results: A total of 1629 patients with ESRD and incident cancer were identified. Overall, the likelihood of nonlocalized stage at diagnosis was not significantly different for patients with ESRD versus the standardized Surveillance, Epidemiology, and End Results general population or matched Medicare control subjects. Stratifying by cancer site, colorectal cancers were significantly more likely to be diagnosed earlier in the ESRD group, whereas prostate cancers were significantly more likely to be diagnosed at a later stage.

Conclusions: With the exception of prostate cancer, patients with ESRD are not more likely to present with later stage malignancies compared with the general population.