Incidence of Infection-related mortality in cancer patients: Trend and survival analysis.

Abstract

e23095 Background: Infectious diseases are the second leading cause of death in the field of oncology. Around 60% of deaths are infection related to cancer patients, especially with underlying hematological malignancies. This study assesses the changing trends of mortality in cancer patients from infectious causes in the past 40 years. Methods: This is a retrospective analysis on 151440 cancer patients who died from infectious causes between 1973 and 2014, identified in the Surveillance, Epidemiology, and End Results (SEER) Program database. Results: Pneumonia and influenza were the most common infections (n = 72133) followed by parasitic diseases and other infections (n = 47310) and septicemia (n = 31119), respectively. The average survival was 65.31 months, while pneumonia and influenza had the highest survival of all. Prostate cancer was the most common cancer associated with infectious diseases (n = 20068) followed by breast cancer (n = 16676) and Kaposi sarcoma (n = 13046), respectively. During 1998-2001, an overshoot in infection-related mortality was significantly noted (APC = 26.74%; 95%CI = 3.7:54.9). However, since 1973, the greatest reduction in infection-related mortality was recorded during 2012-2014 (APC = -37.15; 95%CI = -48.6: -23.2). Compared to other infectious diseases, ‘parasitic and other infections including HIV’ accounted for the highest incidence (SIR = 1.77; 95% CI = 1.69:1.84), where blood vessel tumors occurred the most in this category (SIR = 88.83; 95%CI = 2.25:494.9). Afterward, septicemia was the second most common infectious disease (SIR = 0.84; 95%CI = 0.81:0.88). Except for leukemia, lymphoma, plasma cell tumors, and mast cell tumors, hematologic tumors revealed the highest incidence of septicemia (SIR = 51.9; 95%CI = 1.31:289.16). Gender, race, marital status, an infectious organism, and tumor characteristics (behavior and grade); all accounted for significant differences in survival (P < 0.0001). The nomogram has outstanding discrimination ability (c-index = 0.85) with very minimal differences from the actual observations of 1-, 3-, and 5-year survival probabilities. Conclusions: Infection-related mortality in cancer patients declined from 1973 to 2014. The most common infections in cancer patients were Pneumonia and influenza, followed by parasitic diseases, other infections, and septicemia. Prostate cancer was the most common cancer associated with infectious diseases, followed by breast cancer and Kaposi sarcoma.