Influenza and pneumonia-attributed deaths among cancer patients in the United States; a population-based study

ABSTRACT

Objective: To assess the patterns and trends of influenza and pneumonia-attributed deaths among cancer patients in the United States.

Methods: Surveillance, Epidemiology and End Results (SEER) database was accessed and cancer patients diagnosed 1975–2016 who have been included in the SEER-9 registries were included. The primary endpoint of the study is standardized mortality rate (SMR; calculated as observed/ Expected (O/E) ratio for death from influenza and pneumonia among cancer patients).

Results: The current study evaluates a total of 3,579,199 cancer patients (diagnosed 1975-2016) within the SEER-9 registries; and influenza and pneumonia-attributed deaths represent 1.5% of the recorded deaths for this cohort. SMR for influenza/ pneumonia-attributed death within the first year following cancer diagnosis was 1.88 (1.83-1.94);while SMR for influenza/pneumonia-attributed death following the first year was 1.11 (1.10–1.12). Within the first year following cancer diagnosis, SMR from influenza/pneumonia was higher among individuals with black race (SMR for white race: 1.75 (95% CI: 1.69–1.81) while SMR for black race: 2.90 (95% CI: 2.65–3.16), lung cancer (SMR for lung cancer: 4.39 (95% CI: 4.11–4.69)), head and neck cancer (SMR for oral cavity/ pharynx cancer: 4.02 (95% CI: 3.50–4.59)), lymphomas (SMR for lymphoma: 3.28 (95% CI: 2.92–3.68)), leukemias (SMR for leukemia: 3.32 (95% CI: 2.89–3.80)) and myeloma (SMR for myeloma: 3.91 (95% CI: 3.28–4.63)).

Conclusions: Cancer patients are more likely to have influenza/ pneumonia-attributed death compared to the general US population. This risk is higher among patients with lung cancer, head and neck cancer, and hematological malignancies.

KEYWORDS:

• Influenza
• pneumonia
• cancer
• deaths

Article highlights

● Surveillance, Epidemiology, and End Results (SEER) database was accessed and cancer patients diagnosed 1975–2016 who have been included in the SEER-9 registries were included.● The primary endpoint of the study is standardized mortality rate (SMR; calculated as observed/ Expected (O/E) ratio for death from influenza and pneumonia among cancer patients).● Competing risk analysis was additionally conducted to evaluate the impact of age on influenza/pneumonia-attributed deaths among selected tumor types.● The current study evaluates a total of 3,579,199 cancer patients (diagnosed 1975–2016) within the SEER-9 registries; and influenza and pneumonia-attributed deaths represent 1.5% of the recorded deaths for this cohort.● SMR for influenza/ pneumonia-attributed death within the first year following cancer diagnosis was 1.88 (1.83–1.94); while SMR for influenza/pneumonia-attributed death following the first year was 1.11 (1.10–1.12).● Within the first year following cancer diagnosis, SMR from influenza/pneumonia was higher among individuals with black race (SMR for white race: 1.75 (95% CI: 1.69–1.81) while SMR for black race: 2.90 (95% CI: 2.65–3.16), lung cancer (SMR for lung cancer: 4.39 (95% CI: 4.11–4.69)), head and neck cancer (SMR for oral cavity/ pharynx cancer: 4.02 (95% CI: 3.50–4.59)), lymphomas (SMR for lymphoma: 3.28 (95% CI: 2.92–3.68)), leukemias (SMR for leukemia: 3.32 (95% CI: 2.89–3.80)) and myeloma (SMR for myeloma: 3.91 (95% CI: 3.28–4.63)).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical approval

All procedures performed in studies involving human participants were following the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As this study is based on a publicly available database without identifying patient information, informed consent was not needed.

Additional information

Funding

This paper was not funded.