Fatal Infections Among Cancer Patients: A Population-Based Study in the United States

Abstract

Introduction: Cancer patients are prone to infections, but the mortality of fatal infections remains unclear. Understanding the patterns of fatal infections in patients with cancer is imperative. In this study, we report the characteristics, incidence, and predictive risk factors of fatal infections among a populationbased cancer cohort. Methods: A total of 8,471,051 patients diagnosed with cancer between 1975 and 2016 were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) program. The primary outcome was dying from fatal infections. Mortality rates and standardized mortality ratios (SMRs) adjusted for age, sex, race, and calendar year were calculated to characterize the relative risks of dying from fatal infections and to compare with the general population. Furthermore, cumulative mortality rates and the Cox regression models were applied to identify predictive risk factors of fatal infections. Results: In cancer patients, the mortality rate of fatal infections was 260.1/100,000 personyears, nearly three times that of the general population [SMR, 2.92; 95% (confidence interval) CI 2.91-2.94]. Notably, a decreasing trend in mortality rate of fatal infections was observed in recent decades. SMRs of fatal infections were highest in Kaposi sarcoma (SMR, 162.2; 95% CI 159.4-165.1), liver cancer (SMR, 30.9; 95% CI 30.0-31.8), acute lymphocytic leukemia (SMR, 19.1; 95% CI 17.0-21.4), and acute myeloid leukemia (SMR, 13.3; 95% CI 12.4-14.3). Patients aged between 20 and 39 years old exhibited a higher cumulative mortality rate in the first few years after cancer diagnosis, whereas the cumulative mortality rate of those Yongqiang Zheng, Ying Chen and Kaixu Yu are co-first authors.

Immediate risk of non-cancer deaths after a cancer diagnosis

“…As the second predominant cause of death among patients with cancer after a cancer diagnosis, fatal infections have been interpreted to be a consequence of the immunosuppression induced by the effects of the malignancy itself and by various modern cancer therapies, including chemotherapeutic regimens, hematopoietic stem cell transplantation, invasive procedures, or medical devices and malnutrition [ 17 – 20 ]. Consistent with our previous findings, cancer patients had greater risks of dying from infections, and the degree of the risks was positively correlated with the stages of cancer [ 21 , 22 ]. In our analyses, the particularly high risk of death from infectious diseases in patients with liver cancer may be attributable to its association with acute or chronic viral hepatitis; this elucidated the important role of viral hepatitis in both the development of and mortality from liver cancer [ 23 , 24 ].…”

Tolerability on Serious Adverse Events of First-Line Bevacizumab and Cetuximab for RAS Wild-Type Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

“…We also assessed hepatic and renal toxicity in overall and the related components between the bevacizumab- and cetuximab-based chemotherapy among patients with RAS wild-type mCRC. Furthermore, the risk of infection, the major complication of chemotherapy secondary to neutropenia [ 28 ], was not substantially different between cetuximab ( n = 452)- and bevacizumab ( n = 405)-based chemotherapy for RAS wild-type mCRC. Nonetheless, caution is required when interpreting the study results because AEs are induced by numerous factors including older age, multiple comorbidities, drug combination, drug interactions, route of administration, and treatment duration [ 6 ].…”

Cause of Death Among Patients With Thyroid Cancer: A Population-Based Study

“…For non-cancer causes of death, standardized mortality ratios (SMRs) were assumed to be the ratio of the death toll for patients with thyroid carcinoma to that of the general population. The calculation method for SMRs and associated 95% confidence intervals (CIs) with respect to non-cancer causes of death was as previously described ( 11 , 25 – 27 ). SMRs were calculated as the ratio of the observed number of deaths in cancer patients to the expected number of deaths in the cancer-free population, which had a similar demographic structure in terms of sex, age, race, and the calendar year of study evaluations.…”

“…One important change brought about by the rising population of cancer survivors is the increasing prevalence of deaths from causes other than the index carcinoma, including subsequent second or multiple primary cancers ( 6 ) and non-cancer comorbidities ( 7 , 8 ). Some non-cancer comorbidities, including cardiovascular diseases ( 9 , 10 ), infectious diseases ( 11 ), accidents ( 12 ), peptic ulcers ( 13 ), as well as suicides ( 14 ), have been reported as major threats to cancer patients’ health, survivorship, and quality of life. In addition, the risk of non-cancer comorbidities is increased as a consequence of the malignancy itself as well as the treatments administered.…”