Patients hospitalized with lupus more likely to develop, die from cancer
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Key takeaways:
- Patients with lupus are more likely to develop cancer of the oropharynx, vulvo-vagina, musculoskeletal and hematological tissues.
- Patients with SLE demonstrated an increased risk for mortality at 5 years after cancer development.
Patients who have been hospitalized with systemic lupus erythematous demonstrate an increased risk for multiple cancer subtypes, as well as an increased risk for 5-year mortality after cancer development, according to data.
“Management of SLE patients often requires intensive and long-term use of immunosuppressive medications, the side effects of which, increase the patient's burden of disease,” Warren David Raymond, a PhD candidate at the University of Western Australia, in Perth, and colleagues wrote in the International Journal of Rheumatic Diseases. “Consequently, SLE patients have poorer survival, especially after the onset of infection, cancer, renal failure, myocardial infarction, and central nervous system disorders.”
To investigate the relationship between SLE and cancer development, as well as subsequent mortality, Raymond and colleagues analyzed population-level patient data using the Western Australian Data Linkage System and the Western Australian Rheumatic Disease Epidemiological Registry. Patients with SLE were propensity matched at 1:10 to healthy control patients with no history of rheumatic diseases. The index date for included patients was the date of hospitalization for SLE in patients with SLE, and the date of a random hospitalization for the control patients.
Assessed comorbidities for patients included certain infections and smoking status. Information regarding cancer diagnoses and deaths were acquired from the Cancer Register, which collects information on diagnoses and treatment records, and the Death Register, which collects information on demographics and causes of death for deceased patients.
The analysis included 2,111 patients with SLE and 21,110 control individuals who were hospitalized between 1980 and 2014. According to the researchers, the risk for cancer development was higher in patients with SLE aged younger than 40 years (adjusted HR = 1.58; 95% CI, 1.29-1.94), as well as those hospitalized between 1980 and 1999 (aHR = 1.16; 95% CI, 1.02-1.31). In addition, patients with SLE were more likely to develop cancers impacting the oropharynx, vulvo-vagina, musculoskeletal tissues and hematological tissues.
Those with SLE also demonstrated an increased likelihood of 5-year mortality (adjusted HR = 1.31; 95% CI, 1.06-1.61) after cancer development. Patients aged younger than 50 years (aHR = 2.03; 95% CI, 1.03-4) and those with reproductive system and skin cancers had the highest risks for 5-year mortality.
“Systemic lupus erythematosus patients were at increased risk of some but not all cancer types compared with the general population,” Raymond and colleagues wrote. “Clinicians should be particularly aware of the increased risk of virus-induced cancers, particularly of the oropharyngeal and vulvo-vaginal areas; as well as the increased risk of soft-tissue sarcoma, non-melanoma skin cancer, and non-Hodgkin's lymphoma over time.”
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