title: Resolution of severe hyponatraemia is associated with improved survival in patients with cancer.
abstract: BACKGROUND
  Hyponatraemia is a common finding in patients with cancer, and has been shown to be associated with poor prognosis in different settings. We have analysed the impact of severe hyponatraemia in patients with cancer.
  
  
  METHODS
  A retrospective review of all patients admitted to a specialist cancer hospital with a plasma sodium of less than 115 mmol/l and a diagnosis of malignancy was undertaken. Patient and tumour characteristics were analysed as well as impact of hyponatraemia management on overall survival and number of lines of cancer treatment received.
  
  
  RESULTS
  57 patients were identified. 84% had advanced Stage 3 or 4 cancer and approximately 85% with data available had symptoms attributable to hyponatraemia. Mean length of hospital stay was 12 days, and overall survival (OS) was 5.1 months. Plasma sodium level corrected in 56% of patients and here OS was 13.6 months compared to 16 days in those whose sodium did not correct (p < 0.001). Those whose sodium corrected were more likely to receive further lines of anti-cancer treatment.
  
  
  CONCLUSIONS
  Severe hyponatraemia in cancer is associated with very poor survival, but correction of the sodium level leads to additional treatment and significantly greater overall survival (although it is not possible to determine if this is due to specific therapy of the hyponatraemia or the resolving hyponatraemia reflects an improvement in the clinical condition). Aggressive treatment of hyponatraemia may allow more anti-cancer treatment and improve survival.
authors.affiliation: Department of Medicine, Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK. kirsty.balachandran@doctors.org.uk.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Balachandran
authors.affiliation: Department of Medicine, Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK. alicia.okines@rmh.nhs.uk.
authors.forename: Alicia
authors.initials: A
authors.lastname: Okines
authors.affiliation: Department of Medicine, Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK. ranga.gunapala@rmh.nhs.uk.
authors.forename: Ranga
authors.initials: R
authors.lastname: Gunapala
authors.affiliation: Department of Endocrinology, Chelsea and Westminster Hospital, London, SW10 9NH, UK. d.morganstein@imperial.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Morganstein
authors.affiliation: Department of Medicine, Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK. sanjay.popat@rmh.nhs.uk.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Popat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D055815:Young Adult