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 10 9/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.

Analysis of administrative data

METHODOLOGY

Data source : Master Linked Data Set

Central Cancer
Clinical Cancer
Registry
Registry
Jan 1994 - Dec 2009
Jan 2006 - Dec 2010
540,832 records
453,295 records
Intersecting period
Jan 2006-Dec 2007
Admitted Patient
Mortality data (ABS)
Data Collection
Jan 1985 - Dec 2007
Jul 2000- Dec 2013
1,020,798 records
32,029,904 records

Study Population
Clinical Cancer Registry
(ClinCR)
(n=32694)

Central Cancer Registry

(CCR)
(n=76320)

Admitted Patient Data

(APDC)
(n=253694)

ABS Mortality
(n=33484)

Treatment modality: Medical

oncology and Hematology
(n=13198)
Protocol information
Yes:
(n=9637)
Systemic therapy protocol
Yes:
(n=6984)
Chemo cycle Info
Yes:
(n=6855)

CCR and ClinCR:

Matched
(n=6405)

CCR, ClinCR and APDC:

Matched
(n=6265)

CCR, ClinCR, APDC

and ABS Mortality:
Matched
(n=1409)

Operational definitions
Neutropenia
ICD10 code D70 (Agranulocytosis).

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

Comorbidity Score
Charlsons Comorbidity index excluding
cancer categories9.

Linked data analysis

RESULTS

DEMOGRAPHICS & CLINICAL

CHARACTERISTICS

Study population by cancer diagnosis

1916

2000

31%

1600
1200
800

1188

1114
852

3%

1003

16%
19%

400
Total
0

192

14%
18%

Total
Cancer types

The study population: sociodemographic 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 diagnosis
20-<40 years
40-<50 years
50-<60 years
60-<70 years
70-<80 years
>=80 years

10.3
29.5
29.2
22.9
6.3
1.8

2.0
6.1
21.7
33.2
30.9
6.1

3.1
8.5
21.8
32.2
28.2
6.1

11.9
9.6
17.7
21.4
27.0
12.5

22.9
14.6
22.9
27.1
9.4
3.1

7.4
12.5
22.4
28.7
22.8
6.3

22.8
23.8
16.3
21.1
16.1

19.8
19.5
18.9
25.2
16.6

19.5
22.4
16.7
24.6
16.8

28.9
16.8
17.2
23.5
13.7

32.8
19.3
19.3
19.8
8.9

25.2
21.5
15.0
23.8
14.5

SEIFA
Lowest

Second
Middle
Fourth

The study population: Treatment and

clinical characteristics
Breast
(%)

Lung (%)
N=852

N=1114

Degree of
spread
Localized
Regional
Distant
Treatment
Chemo only
Chemo +
Surgery
Chemo +
Radio
Ch + Radio

Colon/
Rectum
(%)
N=1188

Non
Acute
HM (%)
N=1003

Acute HM
and BMT
(%)
N=192

Other
(%)
N=1916

33.6
58.3
5.0

10.8
27.6
52.5

14.7
46.2
27.2

0.9
0.3
0.6

1.0
0.0
0.0

23.9
24.2
28.2

10.0
21.7
20.0
48.3

33.0
13.7
37.2
16.1

17.6
50.1
7.4
24.9

48.0
24.6
17.7
9.8

51.0
26.0
15.1
7.8

27.9
30.4
19.1
22.6

OUTCOMES AND
CORRELATES

Distribution: Infections and

neutropenia by cancer diagnosis
100

92

85

Infections

80
60

46

42

40
21

20
Proportion
0

29

28
13

16
4

Cancer types

35

32
9

15

Outcome: Infections and neutropenia

CCR, ClinCR and APDC:
Matched
(n=6265)

Neutropenia with
Infections

Neutropenia without
Infections

No neutropenia but
Infection

No Neutropenia
and no infections

13.9% (n=871)

1.4% (n=88)

20.8% (n=1304)

63.9% (n=4002)

Multivariate logistic regression

examining predictors of infection

ORGANISMS PROFILE

Distribution of organisms
100

Gram positive
Gram negative
Fungal

80
Proportion
60

49

40
20
0

22
13

1519
1
0

33

31
25

2927
0

2723

2524
5

Gram positive organisms

100
Streptococcu
s

80
60
40
20
Proportion
0

27
18

17

14

19

10

Cancer types

15

14

Gram negative organisms

100

E. Coli
K. Pneumoniae
other gram negative

80
60
40
20 11
Proportion
0

12

21

16

Cancer types

19

16

PROFILE OF NEUTROPENIC
INFECTIONS

Multivariate logistic regression for factor

associated with neutropenic infections

Profile of Infections
Fever, Unspecified
Other specified fever
Implant infections
Pseudomonas
Unspecified gram negative
org.
Sepsis
Unspecified
Gram negative
Other and specified
staphylococcus

Neutropenia

Pneumonia, unspecified
Unrinary track infections
Escherichia Coli
Stapylococcus Aureas

No neutropenia

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.

References
1.

2.
3.

4.
5.
6.
7.

8.
9.

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.
AIHW & AACR 2012. Cancer in Australia: an overview 2012. Cancer series no. 74. Cat. no. CAN
70. Canberra: AIHW.
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.
Crawford J, Dale DC, Lyman GH. Chemotherapyinduced neutropenia. Cancer. 2004;100(2):228237.
Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated
with febrile neutropenia in adult cancer patients. Cancer. 2006;106(10):2258-2266.
Lyman GH, Michels SL, Reynolds MW, Barron R, Tomic KS, Yu J. Risk of mortality in patients with
cancer who experience febrile neutropenia. Cancer. 2010;116(23):5555-5563.
Smith TJ, Khatcheressian J, Lyman GH, et al. 2006 update of recommendations for the use of
white blood cell growth factors: an evidence-based clinical practice guideline. Journal of Clinical
Oncology. 2006;24(19):3187-3205.
Wood AJ, Pizzo PA. Management of fever in patients with cancer and treatment-induced
neutropenia. New England Journal of Medicine. 1993;328(18):1323-1332.
Thygesen SK, Christiansen CF, Christensen S, Lash TL, Srensen HT. The predictive value of ICD-

THANK YOU