Chemotherapy associated infections among adult cancer patients in NSW,

Australia 2006-2007

Md Hamidul Huque

University of Technology, Sydney

Co-authors: Nicole Gilroy; Richard Walton; Samuel Woolford; Louise Ryan and David Currow.

Background• Infections are the leading causes of disease burden in cancer

patients 1. • Chemotherapy and complicating infections accounted for

more than 40% of cancer-related hospital admissions in

Australia during 2011-122. • Febrile Neutropenia (FN) is the most common infection-related

syndrome in patients receiving chemotherapy1,3-8. • Little data is available in the Australian population context.

Febrile Neutropenia

• Blood disorder (neutrophil count <0.5 × 109/l) associated

with fever.

• Major cause of infections among cancer patients who receive

chemotherapy1-7.

• Higher incidence of hospitalization and mortality irrespective

of cancer types5.

• Causes chemotherapy dose reduction and delays

– compromised treatment outcome

– Increase health care costs3,4,6.

Research Objective

Summarize the burden of serious infections in adult cancer patients (age ≥ 20 years) receiving myelosuppressive chemotherapy using administrative data.

Understand the organisms complicating chemotherapy associated infections.

METHODOLOGYAnalysis of administrative data

Data source : Master Linked Data Set

Clinical Cancer Registry

Jan 2006 - Dec 2010453,295 records

Central Cancer Registry

Jan 1994 - Dec 2009540,832 records

Admitted Patient Data CollectionJul 2000- Dec 201332,029,904 records

Mortality data (ABS)Jan 1985 - Dec 20071,020,798 records

Intersecting periodJan 2006-Dec 2007

Study PopulationCentral Cancer Registry

(CCR)(n=76320)

Clinical Cancer Registry(ClinCR)

(n=32694)

Treatment modality: Medical oncology and Hematology

(n=13198)

Protocol informationYes:

(n=9637)

CCR and ClinCR: Matched

(n=6405)

Systemic therapy protocol Yes:

(n=6984)

ABS Mortality

(n=33484)

Admitted Patient Data (APDC)

(n=253694)

CCR, ClinCR and APDC: Matched

(n=6265)

CCR, ClinCR, APDC and ABS Mortality:

Matched (n=1409)

Chemo cycle InfoYes:

(n=6855)

Operational definitions

• Neutropenia– ICD10 code ‘D70’ (Agranulocytosis).

• Infections – Many definitions.– No single ICD10 codes. – Broad definition (~144 ICD10 codes).

• Comorbidity Score– Charlson’s Comorbidity index excluding cancer

categories9.

RESULTSLinked data analysis

DEMOGRAPHICS & CLINICAL CHARACTERISTICS

Study population by cancer diagnosis

Breast Lung

Colon/ rectu

m

Non acute HM

Acute Le

ukemia

...Oth

er0

400

800

1200

1600

2000

1114852

11881003

192

1916

Cancer types

Tota

l

Total

18%

14%

19%

16%

3%

31%

The study population: socio-demographic characteristics

Breast (%)

N=1114

Lung (%)

N=852

Colon/ Rectum (%)N=1188

Non Acute HM (%)N=1003

Acute HM and BMT (%)N=192

Other (%)

N=1916

Female 99.6 40.4 41.6 40.3 40.6 44.0

Age at diagnosis20-<40 years40-<50 years50-<60 years60-<70 years70-<80 years

>=80 years

10.329.529.222.9

6.31.8

2.06.1

21.733.230.9

6.1

3.18.5

21.832.228.2

6.1

11.99.6

17.721.427.012.5

22.914.622.927.1

9.43.1

7.412.522.428.722.8

6.3

SEIFA LowestSecondMiddleFourth

Highest

22.823.816.321.116.1

19.819.518.925.216.6

19.522.416.724.616.8

28.916.817.223.513.7

32.819.319.319.8

8.9

25.221.515.023.814.5

The study population: Treatment and clinical characteristicsBreast (%)

N=1114

Lung (%)

N=852

Colon/ Rectum (%)N=1188

Non Acute HM (%)N=1003

Acute HM and BMT (%)N=192

Other (%)

N=1916

Degree of spread Localized Regional Distant

33.658.3

5.0

10.827.652.5

14.746.227.2

0.90.30.6

1.00.00.0

23.924.228.2

Treatment Chemo only Chemo + Surgery Chemo + Radio Ch + Radio + Sug

10.021.720.048.3

33.013.737.216.1

17.650.1

7.424.9

48.024.617.7

9.8

51.026.015.1

7.8

27.930.419.122.6

>1 protocol 32.2 17.2 19.2 20.7 54.2 18.5

>1 comorbidity 11.3 42.3 30.6 41.6 35.4 36.9

OUTCOMES AND CORRELATES

Distribution: Infections and neutropenia by cancer diagnosis

Breast Lung

Colon/ rectu

m

Non acute HM

Acute Le

ukemia

...Oth

erTotal

0

20

40

60

80

100

21

4228

46

92

32 35

13 164

29

85

915

InfectionsNeutropenia

Cancer types

Prop

ortio

n

Outcome: Infections and neutropenia

CCR, ClinCR and APDC: Matched

(n=6265)

Neutropenia withInfections

13.9% (n=871)

Neutropenia withoutInfections

1.4% (n=88)

No neutropenia butInfection

20.8% (n=1304)

No Neutropenia and no infections

63.9% (n=4002)

Multivariate logistic regression examining predictors of infection

ORGANISMS PROFILE

Distribution of organisms

Breast Lung Colon/ rectum

Non acute HM

Acute Leukemia and BMT

Other Total0

20

40

60

80

100

2215

29 31

49

25 2713 19

27 2533

24 23

0 1 0 2 5 0 1

Gram positiveGram negativeFungal

Prop

ortio

n

Gram positive organisms

Breast Lung

Colon/ rectu

m

Non acute HM

Acute Le

ukemia

a...

Other

Total0

20

40

60

80

100

18

7

17 1419

15 14

2 4 410

27

4 7

StreptococcusStaph aureusOther staph

Cancer types

Prop

ortio

n

Gram negative organisms

Breast Lung Colon/ rectum

Non acute HM

Acute Leukemia and BMT

Other0

20

40

60

80

100

11 1221 16 19 16

E. ColiK. Pneumoniaeother gram negative

Cancer types

Prop

ortio

n

PROFILE OF NEUTROPENIC INFECTIONS

Multivariate logistic regression for factor associated with neutropenic infections

Profile of Infections

•Pneumonia, unspecified•Unrinary track infections•Escherichia Coli•Stapylococcus Aureas

Neutropenia No neutropenia

•Fever, Unspecified•Other specified fever•Implant infections•Pseudomonas•Unspecified gram negative org.•Sepsis • Unspecified• Gram negative• Other and specified

staphylococcus

Summary• Hematologic malignancy, higher comorbidity scores, use of

>1 protocols and presence of neutropenia pose a significant risk of infections.

• Prevalence of Gram positve infections was significantly higher compared to the gram negative infections.

• Fever, sepsis and Impant infections were associated with neutropenic infections whereas non neutropenic infections was common among patient with respiratory infections and UTI.

• Psedomonas sp and unspecified gram negative organisms were significantly associated with neutropenic infections.

References1. National Comprehensive Cancer Network, Inc 2013. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines):

Prevention and treatment of cancer-related infections. V. 1.2013. NCCN.org.2. AIHW & AACR 2012. Cancer in Australia: an overview 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW.3. Aapro M, Bohlius J, Cameron D, et al. 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating

factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. European journal of cancer. 2011;47(1):8-32.

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