WTC: Elevated Cancer Risk a Surprise to Organ Recipients

BOSTON, July 24 -- Many patients don't learn until after transplant surgery that they are suddenly at a much higher risk for cancer mortality, a National Kidney Foundation survey found.

They had no idea that cancer is the third leading cause of death among long term survivors of solid organ grafts, surgeon E. Steve Woodle, M.D., director of transplantation at the University of Cincinnati, and colleagues, reported at the World Transplant Congress here.

A transplant recipient on immunosuppressive therapy has a three- or fourfold greater risk of developing cancer compared with the general population, according to the survey of the attitudes of transplant recipients toward cancer risk.

Kidney transplant recipients surveyed said that their primary post-transplant concerns were rejection and infection, although about 85% of kidney recipients will not have an episode of rejection in the first year after surgery, said Dr. Woodle.

Cancer registry data from Australia and New Zealand indicate that after 25 years, about 80% of transplant survivors will develop some form of cancer, the majority of which will be skin cancers. But about 30% of all cancers that occur in long-term transplant survivors are non-skin malignancies, Dr. Woodle said.

To get a handle on what transplant recipients know-and what they think they know-about the risk of cancer and other complications post-transplant, the Kidney Foundation first sponsored a series of focus group sessions in which they invited transplant recipients to share their thoughts and concerns about cancer and other potential health problems. One of the goals of the sessions was to determine how well the risks were being communicated by clinicians, including members of the transplant team and the patient's primary care practitioner.

The information from the focus group sessions was then used to craft a questionnaire which was mailed or e-mailed to kidney transplant recipients.

A total of 584 patients responded (total response rate about 66%).

Nearly one fourth of respondents (23%) said they learned about cancer risk only after their surgery, and only one-third said they actually recalled being told by a health care professional about the risk prior to surgery.

In the focus group sessions conducted prior to the survey, one of the participants said he learned about the cancer risk over breakfast with a "transplant buddy."

"Patients want to hear about cancer risk after transplantation earlier than when they remember hearing about, " Dr. Woodle commented. Some respondents said that had they known about the risk earlier, it might have affected their decision to have surgery.

Two-thirds of patients said they wanted to know more about their cancer risk, but many also did not discuss cancer risks or cancer prevention with their primary care physicians regularly, including 22% of cancer survivors, the survey found.

The study authors recommend that physicians inform patients prior to transplant surgery of elevated cancer risk associated with immunosuppressive therapy, and work with them to ensure that they take whatever steps possible to mitigate their risk, Dr. Woodle said.

The full report will be made available to the transplant community later this year, according to the Kidney Foundation.

The World Transplant Congress is a joint meeting of the American Society of Transplant Surgeons, American Society of Transplantation, and The Transplantation Society.