Comparison of the Effects of Diuretics on Pedal Edema in Patients with Cancer

The effectiveness of tolvaptan (T) for treating pedal edema remains unknown.

We aimed to clarify the effectiveness of diuretics, including T, on pedal edema in advanced cancer patients, and to compare patients' versus physicians' assessments of the effects.

Participants comprised 88 hospitalized cancer patients treated with T, loop diuretics (L), or spironolactone (S). Patient characteristics, initial doses of diuretics, reason for discontinuation, side effects, evaluation of pedal edema, and effects of diuretics on pedal edema were investigated retrospectively using electronic medical records.

The rates of improvement of pedal edema according to patients (Pt) and physicians (MD) were T: Pt 83.3% (n = 6), MD 71.4% (n = 14); L: Pt 57.1% (n = 14), MD 50.0% (n = 26); S: Pt 0% (n = 1), MD 57.1% (n = 7); L+S: Pt 83.3% (n = 12), MD 69.0% (n = 29); T+L: Pt 90.9% (n = 22), MD 71.8% (n = 39); T+S: Pt 0% (n = 1), MD 0% (n = 2); T+L+S: Pt 62.5% (n = 8), MD 69.2% (n = 13). In 57.1%-90.9% and 50.0%-71.8% of episodes, patients and physicians, respectively, observed some effectiveness of diuretics on pedal edema in advanced cancer, except for in the S (Pt) and T + S (Pt, MD) groups.

The treatment of pedal edema improves patient symptoms, enhancing quality of life. Further verification and evaluation of the effect of T on pedal edema are needed.