Adherence to the Sociedad Española de Oncología Médica (SEOM) Algorithm for the Treatment of Hyponatremia in Oncology Patients in Spain: The ALGA Study

• Published in: Advances in therapy 2021, Vol.38 (1), p.290-303
• Main Authors: Henao, Fernando, Manzano, Aranzazu, Lopez Lopez, Rafael, Gobartt, Ana Luisa, de las Peñas, Ramón
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Algorithms; Cardiology; Endocrinology; Humans; Hyponatremia - epidemiology; Hyponatremia - therapy; Internal Medicine; Medicine; Medicine & Public Health; Neoplasms; Oncology; Original Research; Pharmacology/Toxicology; Retrospective Studies; Rheumatology; Spain
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-020-01532-6

Introduction The ALGA study explored adherence of Spanish treatment centers to the Sociedad Española de Oncología Médica (SEOM) treatment algorithm for oncology patients with hyponatremia that requires treatment as the main cause of hospitalization, and evaluated the impact of adherence to this algorithm on patient outcomes. Methods This retrospective study recruited patients aged at least 18 years with cancer, treated for at least one episode of hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The primary outcome was the proportion of patients whose treatment adhered to the SEOM algorithm, evaluated using a pre-defined decision tree. Secondary outcomes included length of hospitalization, and time to serum sodium level improvement. Perceived center adherence to the SEOM algorithm was also assessed. Results Seventy patients from four treatment centers were included. Twenty (28.6%; 95% confidence interval [CI] 18.0, 39.2) patients on hyponatremia treatment adhered to the SEOM algorithm, with a perceived adherence of 51.0–75.0%. Algorithm adherence in candidates for chemotherapy was 36.4% ( n  = 8) versus 25.0% ( n  = 12) for non-candidates for chemotherapy. Median time to serum sodium level improvement in patients managed adherently was 80.5 h (95% CI 38.3, 331.4) versus 134.6 h (33.2, 444.9) in patients managed non-adherently. Median time to hospital discharge was 16.5 days (95% CI 8.0, 27.0) in patients managed adherently versus 9.5 days (7.0, 22.0) in patients managed non-adherently. Conclusion In Spanish centers, the SEOM algorithm was adhered to in less than one-third of patients, in contrast to higher levels of perceived adherence. This requires further investigation; however, algorithm use could require further clarification, especially in non-candidates for chemotherapy. Plain Language Summary Low levels of sodium in the blood occur in almost half of patients with cancer who are hospitalized. In some patients, this may be fatal. A care pathway was developed by the Sociedad Española de Oncología Médica in 2014 to support doctors in providing the best care for these patients. Clinical records for 70 patients with cancer at four Spanish hospitals were reviewed to determine whether treatment was given according to the care pathway. Less than one-third of patients were found to have been treated according to the pathway. Patients receiving chemotherapy were more likely to have been treated according to the pa