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Screening, Diagnosis, and Treatment of Cancer in Long-Term Dialysis Patients

University of Virginia Health System, Nephrology Division, Charlottesville, Virginia

Address correspondence to: Dr. Jean L. Holley, University of Virginia Health System, Nephrology Division, Box 800133, Charlottesville, VA 22908. Phone: 434-924-5125; Fax: 434-924-5848; E-mail: jlh4qs{at}virginia.edu

Some have suggested that the American Cancer Society guidelines for cancer screening be applied to patients who are on long-term dialysis and have used cancer screening as a means of assessing delivered preventive health care to patients with ESRD. However, cancer screening is effective only when it leads to survival benefit (usually expressed as days of life saved) without incurring high financial costs. Certain cancers such as human papillomavirus–associated cervical and tongue cancer and urologic malignancies are more common among dialysis patients, yet because the expected remaining lifetime of most dialysis patients is shorter than the time lived to develop malignancy, cancer screening in dialysis patients as applied to the general population is ineffective from the perspective of both cost and survival benefit. Cancer screening in dialysis patients is therefore best provided in an individual patient-focused manner. The occurrence, diagnosis, and treatment of cancer as well as issues related to cancer screening in dialysis patients are discussed.

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