Michael Perry, MD

The increasing number of patientson chronic renal replacementtherapy translates to additionalpatients living long enoughto develop a malignancy. For the mostpart this population will also be elderly,adding the nuances associated withpracticing oncology in a geriatric population.As discussed by Eneman andPhillips, the use of chemotherapeuticagents in patients with end-stage renaldisease (ESRD) is complicated byboth practical and ethical issues.

The article by Eklund, Trifilio,and Mulcahy begins to addressthe difficulties involved in dealingwith a special patient population-those with impaired hepatic function.The issues involved in dealing withabnormal liver function are distinctfrom those encountered with end-stagerenal disease (to be discussed in theAugust issue of ONCOLOGY); hepaticfunction due to tumor may improvewith successful therapy, while for dialysispatients, their renal disease isconsidered permanent.