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Childhood cancer survivors at long-term risk for infection-associated mortality
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The risk for infections and infection-associated mortality among long-term survivors of childhood cancer continues to increase with time from diagnosis, study results suggest.
Joanna L. Perkins, MD, MS, of Children’s Hospitals and Clinics of Minnesota, and colleagues compared infection rates among 5-year survivors of childhood cancer (n=12,360) and their siblings (n=4,023). Researchers compared infection-related mortality among cancer survivors with that of the general US population.
Joanna L. Perkins
Results showed survivors of childhood cancer were at more than 4 times as likely as the general population to die from infection-related causes (standardized mortality ratio [SMR]=4.2; 95% CI, 3.2-5.4). Survivors with the greatest risk for infection-related mortality were females (SMR=3.2; 95% CI, 1.5-6.9) and those who underwent total body irradiation (SMR=7.8; 95% CI, 1.8-33).
Researchers also reported a higher overall rate of infectious complications among cancer survivors compared with siblings (RR=1.3; 95% CI, 1.2-1.4). Survivors also had a higher rate of pneumonia (RR=3.7; 95% CI, 2.6-5.3), hepatitis (RR=2.5; 95% CI, 2-3.3) and sinusitis (RR=1.8; 95% CI, 1.6-1.9).
Multivariable analysis identified several factors associated with higher rates of overall late infectious complications among survivors of childhood cancer. Those factors were female sex (RR=1.7; 95% CI, 1.6-1.8), a diagnosis of Hodgkin’s lymphoma (RR=1.3; 95% CI, 1.2-1.6) and older age at cancer diagnosis.
Increased rates of late gastrointestinal infections were observed in survivors who had a history of total body irradiation or chemotherapy. Increased rates of chronic gingivitis were observed in survivors who reported steroid use (RR=1.3; 95% CI, 1.1-1.6). Survivors who reported being current smokers (RR=1.4; 95% CI, 1.2-1.5) or former smokers (RR=1.3; 95% CI, 1.1-1.5) had increased rates of sinopulmonary infections.
“Further investigation is needed to provide insight into the mechanisms for the observed excess risks,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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