Incidence of late‐onset pneumonia in patients after treatment with radiotherapy for nasopharyngeal carcinoma: A nationwide population‐based study

Yen, Ting-Ting; Lin, Ching‐Heng; Jiang, Rong–San; Shih, Yi-Ting; Yen, Hung-Rong; Liang, Kai‐Li

doi:10.1002/hed.23827

Cited by 25 publications

(21 citation statements)

References 35 publications

(75 reference statements)

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“…The cancer treatment modalities possibly affecting immune system or susceptibility to pneumonia (surgery, radiotherapy, chemotherapy, and target therapy) were adjusted accordingly. 23 – 25 Comorbidities considered in our analysis included a number of major illnesses, such as coronary heart disease, interstitial pulmonary disease, asthma, congestive heart failure (CHF), COPD, liver cirrhosis, diabetes mellitus (DM), chronic renal failure, systemic lupus erythematosus (SLE), stroke, and dementia; these were found to significantly impact CAP cause and outcome. 26 Insurance premium for each NHI beneficiary was proportional to his or her wages; a higher premium indicated higher wages.…”

Section: Methodsmentioning

confidence: 99%

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

et al. 2015

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To evaluate effectiveness of 23-valent pneumococcal polysaccharide vaccine (PPSV23) inoculated during defined “vaccination period,” first 6 months post cancer diagnosis (ie, an anti-cancer treatment period), in elderly lung cancer patients on community-acquired pneumonia (CAP) hospitalization incidence.This was a nationwide population-based cohort study of 157 newly diagnosed elderly lung cancer patients receiving PPSV23 during “vaccination period”, and 628 age and sex one-to-one matched controls enrolled in the National Health Insurance Research Database (NHIRD) of Taiwan between 2007 and 2010. All patients were ≥75 years old and still survival post “vaccination period.” Incidence density (ID) of all-cause inpatient CAP and cumulative survival risk were analyzed by multivariate Poisson regression and Kaplan–Meier method, respectively.After a 4-year follow-up, IDs of all-cause inpatient CAP for vaccination and control cohorts were 297 and 444 per 1000 PYs, respectively. Less vaccinated patients had CAP incidence density >1 time per PY (12.7% vs 21.2%) than non-vaccinated patients. After adjusting for potential confounding variables, like influenza vaccination, comorbidities, cancer treatment modalities, and socioeconomic status, adjusted inpatient CAP incidence rate in PPSV23 vaccination cohort was 0.74 times lower than control cohort (incidence rate ratio [IRR] = 0.740, P = 0.0339). Two-year cumulative CAP hospitalization rates and overall survival rates were 37.1% vs. 55.4%, and 46.6% vs. 26.2%, respectively, for lung cancer patients with and without PPSV23 (both P < 0.001). Subgroup analysis showed that for elderly lung cancer patients not ever receiving influenza vaccine, PPSV23 still had trend to reduce all-cause inpatient CAP.For elderly lung cancer patients aged ≥75 years, PPSV23 inoculated during anti-cancer treatment period could reduce CAP hospitalizations and improve survival.

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Section: Methodsmentioning

confidence: 99%

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

et al. 2015

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“… 62 63 Thus, an increased risk of secondary infectious pneumonia is reasonable, as this phenomenon has been observed in irradiated nasopharyngeal cancer patients. 64 In molecular biology, several genetic variants of irradiation-responsive genes (eg, polymorphisms of XRCC1 , 65 P53 , 66 ATM 66 and APEX1 65 67 ) and TGF-β1 68 have been reported to be as potential biomarkers or predictors in predicting radiation-associated pneumonitis and pneumonia. Thus, these genes might be involved in the underlying pathological processes.…”

Section: Discussionmentioning

confidence: 99%

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study

et al. 2017

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ObjectivePulmonary radiotherapy has been reported to increase a risk of pneumonopathy, including pneumonitis and secondary pneumonia, however evidence from population-based studies is lacking. The present study intended to explore whether postoperative irradiation increases occurrence of severe pneumonopathy in lung cancer patients.Design, setting and participantsThe nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered >99% of Taiwanese) in a real-world setting. From 2000 to 2010, 4335 newly diagnosed lung cancer patients were allocated into two groups: surgery-RT (n=867) and surgery-alone (n=3468). With a ratio of 1:4, propensity score was used to match 11 baseline factors to balance groups.Interventions/exposure(s)Irradiation was delivered to bronchial stump and mediastinum according to peer-audited guidelines.Outcome(s)/measure(s)Hospitalised pneumonia/pneumonitis-free survival was the primary end point. Risk factors and hazard effects were secondary measures.ResultsMultivariable analysis identified five independent risk factors for hospitalised pneumonopathy: elderly (>65 years), male, irradiation, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Compared with surgery-alone, a higher risk of hospitalised pneumonopathy was found in surgery-RT patients (HR, 2.20; 95% CI, 1.93–2.51; 2-year hospitalised pneumonia/pneumonitis-free survival, 85.2% vs 69.0%; both p<0.0001), especially in elderly males with COPD and CKD (HR, 13.74; 95% CI, 6.61–28.53; p<0.0001). Unexpectedly, we observed a higher risk of hospitalised pneumonopathy in younger irradiated-CKD patients (HR, 13.07; 95% CI, 5.71–29.94; p<0.0001) than that of elderly irradiated-CKD patients (HR, 4.82; 95% CI, 2.88–8.08; p<0.0001).ConclusionsA high risk of hospitalised pneumonopathy is observed in irradiated patients, especially in elderly males with COPD and CKD. For these patients, close clinical surveillance and aggressive pneumonia/pneumonitis prevention should be considered. Further investigations are required to define underlying biological mechanisms, especially for younger CKD patients.

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“…Cancer treatment modalities were adjusted, including surgery, radiotherapy, chemotherapy and targeted therapy. 9–11 Additionally, because most patients received both the PPSV23 and influenza vaccines, the influenza vaccination status was also considered as a potential confounder and adjusted in the analysis.…”

Section: Methodsmentioning

confidence: 99%

“… 8 Cancer treatment modalities (surgery, radiotherapy, chemotherapy and targeted therapies) can impair the immune system and thereby increase susceptibility to pneumonia. 9–11 Anticancer therapies may also affect the immune response to vaccination, with their ability to prevent development of an adequate immune response to influenza or pneumococcal pneumonia vaccine remaining controversial. A previous study showed a significantly weaker serum antibody response to influenza virus vaccine in patients receiving cancer chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of 23-valent pneumococcal polysaccharide vaccine on elderly long-term cancer survivors: a population-based propensity score matched cohort study

et al. 2018

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ObjectiveThe Advisory Committee on Immunization Practices in 2012 recommended the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for adults with high risk of pneumonia. However, its effectiveness in cancer survivors has not been investigated. Our aim was to investigate the effectiveness of PPSV23 in these patients.DesignPopulation-based matched cohort study.SettingClaim data were obtained from 1 million people registered with the National Health Insurance Research Database in 1996, and followed to 2010. People aged ≥75 years are eligible for receiving PPSV23 vaccination in Taiwan since 2007.ParticipantsAmong the 30 249 patients with cancer, 6784 patients were 75 years or older eligible for PPSV23 vaccination. Among them, 1887 survived 5 or more years (ie, cancer survivors) after cancer diagnosis. We identified 377 cancer survivors who received PPSV23. A total of 754 propensity score matched unvaccinated patients were randomly selected.InterventionPPSV23 vaccination.Primary outcome measuresThe primary outcome was pneumonia hospitalisation. Potential confounders include influenza vaccination, vaccination period, cancer treatment modalities, comorbidities and sociodemographic variables.ResultsAfter 2 years of follow-up, vaccinated patients had a significantly lower incidence rate of pneumonia hospitalisation at 73.66 per 1000 person-years (PYs), compared with 117.82 per 1000 PYs for unvaccinated patients. Additionally, the prevalence for pneumonia hospitalisation frequency of >0–1,>1–2,>2–3 and >3 times per PY was all consistently lower in the vaccinated group (6.63% vs 9.28%, 1.86% vs 2.52%, 0.80% vs 1.59% and 0.27% vs 0.53%, respectively). After adjustment for covariates, PPSV23 vaccine was significantly associated with reduced pneumonia hospitalisation risk, with an adjusted incidence rate ratio of 0.695 (p=0.030). While the cumulative pneumonia incidence was also significantly lower in the vaccinated patients (p=0.027), the overall survival time was similar (p=0.136).ConclusionsPPSV23 vaccination was associated with a significantly reduced rate of pneumonia hospitalisation in long-term cancer survivors.

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Incidence of late‐onset pneumonia in patients after treatment with radiotherapy for nasopharyngeal carcinoma: A nationwide population‐based study

Abstract: Late-onset pneumonia is not uncommon in patients with NPC after radiotherapy. The risks of associated sequelae and mortality cannot be ignored.

Cited by 25 publications

References 35 publications

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

Effect of 23-Valent Pneumococcal Polysaccharide Vaccine Inoculated During Anti-Cancer Treatment Period in Elderly Lung Cancer Patients on Community-Acquired Pneumonia Hospitalization

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study

Effectiveness of 23-valent pneumococcal polysaccharide vaccine on elderly long-term cancer survivors: a population-based propensity score matched cohort study

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