Adoption of behavioral restrictions as anti-infective measures: A survey among solid tumor patients.

Abstract

2081 Background: Despite lack of evidence, a wide range of rigorous behavioral and social restrictions are recommended in various guidelines and websites in an attempt to mitigate infections. These include patient guided sites. We aimed to study the practices of patients with solid tumors treated with active therapy. Methods: We conducted an anonymous survey among cancer patients treated at a tertiary care center, addressing behavioral approach to infection prevention, by assessing adopted social (seven items), environmental (five items), and dietary (eight items) limitations, as well as compliance to influenza vaccinations. Clinical data included neutropenic fever (NF), and therapy myelosuppressive potential. Multivariable Poisson regression adjusted for sex, age, disease status, therapy to estimate the impact of these restrictions. Results: 214 patients with solid tumors responded to the survey, the majority female (59%), with a median age of 63. The most common tumor types included breast (28%), lung (14%), and colon (9.3%). Most (68%) were treated with chemotherapy, 17% with immunotherapy, 11% with biologicals and 3% with chemo-immunotherapy. Only 6% were admitted for NF. Sources of information regarding restrictions included physicians (4%), nurses (32.9%), and internet (9.8%); the majority were self-imposed. 53% maintained environmental limitations (traveling, sun exposure, hair dying), 37% adopted social restrictions (abstained from children, public places), and 21% affirmed dietary constraints (raw vegetables, tap water consumption). Females practiced stricter environmental and dietary restraint (p < 0.05), with a numerical trend reflecting stricter female social measures (p < 0.4). With no difference in practices among patients treated for a malignant disease and curative intent, and no difference in practice across therapies, in those treated with chemotherapy and immuno-therapy. 37% affirmed difficulty in adherence to these limitations. Conclusions: Our findings indicate that despite lack of evidence, cancer patients adopt anti-infective behavioral measures, which have a deleterious impact on quality of life. These practices are being used even among patients at low or no risk of NF. These findings call for implementation of an education program and development of practical instructions enabling patients to resume their normal life