Lung Cancer: Lung Cancer I |

Treatment of Hyponatremia in Lung Cancer Patients With Moderate to Severe Hypervolemic or Euvolemic Hyponatremia FREE TO VIEW

Jorge Castillo, MD; Ilya Glezerman, MD; Holly Krasa, MS; Lois Lamerato, PhD; Joseph Chiodo, PharmD; Beni Tidwell, BS; Kathy Schulman, MA
Author and Funding Information

Outcomes Research Solutions, Inc., Waltham, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):694A. doi:10.1016/j.chest.2016.08.789
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Hyponatremia is a negative prognostic indicator in lung cancer (LC) but it’s unclear if it’s a marker of severe disease or if correction improves patient care. We characterized treatment and survival in LC patients with moderate/severe hyponatremia.

METHODS: Data was abstracted from tumor registry, administrative files and medical records at the Henry Ford Health System (HFHS) for adults with incident LC if they experienced ≥1 episode of moderate (125-130 mEq/L) or severe (<125 mEq/L) hypervolemic or euvolemic hyponatremia, were continuously enrolled in HFHS’s Health Alliance Plan (HAP) for ≥12 months prior to and ≥1 month after the date (index) of the first serum sodium (Na+) value ≤130, and had no evidence of hypovolemic hyponatremia. Patients were followed until death, HAP disenrollment, clinical trial entry or the onset of a new primary cancer.

RESULTS: Fifty-four LC patients were identified; 19% small-cell, 68% stage 4, 63% male, mean age 63 years. Most patients experienced moderate (87%) vs. severe (13%) hyponatremia; 46% were symptomatic. The most common symptoms were fatigue, confusion, headache, muscle weakness and nausea/vomiting. Mean (SD) duration of moderate/severe hyponatremia was 19 (36.0) days with the majority of hyponatremia untreated (72% moderate, 57% severe). The most common active therapies were fluid restriction and furosemide. Treated patients were significantly (p=.03) more likely to have Na+>130 at 72 hours. Thirty-seven percent of patients experienced another episode of moderate/severe hyponatremia. In the 30 days prior to index, 52% were hospitalized, 39% (24%) received chemotherapy (radiation), 19% were designated a fall risk and 9% experienced a fall. In the 30 days post index, 26% of patients were hospitalized, 44% (28%) received chemotherapy (radiation), 26% received comfort care, 32% were designated a fall risk and 4% experienced a fall. A total of 40 (74%) patients died. Median (95% CI) survival time was 95 (53-165) days; 15% died in the first 30 days.

CONCLUSIONS: Moderate/severe hyponatremia in LC patients is largely untreated despite evidence that a subset of patients are living with the condition for an extended period of time.

CLINICAL IMPLICATIONS: While some form of end of life or comfort care frequently accompanies moderate/severe hyponatremia, the majority of patients in our study lived in excess of three months. The potential exists to improve patient care and outcomes by actively treating hyponatremia.

DISCLOSURE: Jorge Castillo: Consultant fee, speaker bureau, advisory committee, etc.: Paid consultant to Otsuka, Grant monies (from industry related sources): Grants from Millennium, Pharmacyclics and Gilead Ilya Glezerman: Consultant fee, speaker bureau, advisory committee, etc.: Otsuka Advisory Board Holly Krasa: Employee: Otsuka Lois Lamerato: Grant monies (from industry related sources): Grants from ORS who is a consultant to Otsuka Joseph Chiodo: Employee: Otsuka Beni Tidwell: Employee: Employee of ORS who received consultancy fees Kathy Schulman: Consultant fee, speaker bureau, advisory committee, etc.: ORS is a paid consultant to Otsuka

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