Pattern of electrolyte abnormalities among cancer patients referred to palliative care: a review of 750 patients

Background: Electrolyte abnormalities, especially when severe, may increase the symptomatic burden on the terminally-ill cancer patients. This study aimed at determining the pattern of electrolyte abnormalities in hospitalized cancer patients at the time of their referral to a palliative care team. Methods: We retrospectively reviewed the medical records of hospitalized adult cancer patients upon their first referral to a palliative care team. The study period covered 25 months. The electrolytes studied included potassium, sodium, calcium and magnesium. The most abnormal value observed on the day of referral +/- 7 days is taken as the value of interest for a particular electrolyte for a given patient. The degree of abnormality in the level of electrolytes is classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0. Results: From 1137 referrals, 750 (66%) patients were eligible for the study. Among these, 590 (79%) had at least one electrolyte abnormality and 163 (22%) had 3 or more electrolyte abnormalities. About 38% of patients had at least one electrolyte abnormality of grade 3 or 4. The most prevalent electrolyte abnormalities were hyponatraemia (59%), hypomagnesaemia (42%), hypokalaemia (41%) and hypercalcaemia (23%). Conclusions: Electrolyte abnormalities are common and often severe among cancer patients referred to palliative care. Further studies are warranted to correlate between electrolyte abnormalities and the clinical presentation of palliative care cancer patients and the potential impact of routine assessment and management of such abnormalities on their overall well-being.