ASPO Abstracts
A Prospective Study of Cancer Survivors and Risk of Sepsis Within the REGARDS Cohort
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research, Cancer Health Disparities
Conference Year: 2018
Abstract Body:
INTRODUCTION: The aims of this study were to compare the risk of sepsis between cancer survivors and no cancer history participants and whether these differences were modified by race. METHODS: We performed a prospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We categorized participants as “cancer survivors” or “no cancer history” derived from self-reported responses of being diagnosed with any cancer, excluding non-melanoma skin cancer. We defined sepsis as hospitalization for a serious infection with 2 systemic inflammatory response syndrome criteria. We performed Cox proportional hazard models to examine the risk of sepsis after cancer, and stratified by race. In a secondary analysis, we used the Fine & Gray model to examine all-cause mortality as a potential competing risk for sepsis events. We sequentially adjusted our models for 1) sociodemographics, 2) health behaviors, and 3) chronic medical conditions, biomarkers, and baseline medication use. RESULTS: Among 29,693 eligible participants, 2959 (9.97%) were cancer survivors, and 26,734 (90.03%) were no cancer history participants. Cancer survivors were older, more likely to be male, have White race, lower income, past tobacco use, and have a greater number of comorbidities. Among 1393 sepsis events, the risk of sepsis was higher for cancer survivors (adjusted HR: 2.61, 95% CI: 2.29 — 2.98) when compared to no cancer history participants. Risk of sepsis after cancer survivorship was similar for both Blacks (adjusted HR: 3.10, 95% CI: 2.42 — 3.97), and White participants (adjusted HR: 2.45, 95% CI: 2.10 — 2.86) (p value for race and cancer interaction = 0.63). CONCLUSION: In this prospective cohort of community dwelling adults, regardless of race and after controlling for sociodemographic, health behaviors, and comorbidity characteristics, we observed that cancer survivors had more than a 2.5-fold increased risk of sepsis.
Keywords: Sepsis, Cancer, and Racial Disparities