Association Of Cancer Site And Treatment Type With The Risk Of Sepsis-Related Mortality In A Multiethnic Hawaii Population

Sepsis is a severe systemic inflammatory immune response to infection, which may lead to multiple organ failure and is associated with a 70% death rate. The risk of sepsis is higher in immunosuppressed individuals such as cancer patients. The risk of sepsis-related death among cancer patients may differ by cancer site and the administered cancer treatment. We examined the differences in the risk of sepsis-related mortality by cancer site and cancer treatment type among the 103,898 Hawaii participants of the Multiethnic Cohort Study (MEC), including 29,255 prevalent and incident cancer cases, followed for the period of 17-22 years. The participants were men and women aged 45-75 at cohort entry, primarily of Japanese American, Native Hawaiian or White race/ethnicity. Incident cancer cases were identified through linkage with the Hawaii Tumor Registry. Deaths due to sepsis (n=1,818) were identified as those with a primary or contributing cause of death ICD-10= A40-A41. Relative risk ratios (RR) and 95% confidence intervals (CI) were estimated using competing risk Cox regression with age as the time metric and with adjustment for participants9 sex, race/ethnicity, and comorbidities at baseline (diabetes, cardiovascular disease, hypertension and stroke). Stratified analyses were conducted by sex and racial/ethnic group. The risk of sepsis-related death was not significantly different between cohort participants with and without cancer diagnosis (RR: 0.95; 95% CI: 0.85-1.06). In cancer-specific analyses, colorectal cancer diagnosis was associated with higher risk of sepsis death (RR: 1.41; 95% CI: 1.12-1.80), while lung cancer diagnosis was associated with lower risk of sepsis death (RR: 0.41; 95% CI: 0.31-0.55) compared to patients with cancer at all other organ sites. These associations were consistent across sexes and racial/ethnic groups, but only the association with lung cancer was statistically significant within most sex/ethnic groups. No association was observed between chemotherapy and sepsis death. Radiation treatment was associated with lower risk of sepsis death (RR: 0.69; 95% CI: 0.57-0.83). This association was consistent across sexes and racial/ethnic groups but was only statistically significant among Japanese and White women, possibly reflecting larger size and number of cancer cases with radiation therapy in these groups. In this study, we found that the risk of sepsis-related mortality is differentially affected by cancer at certain sites and by the type of cancer treatment administered. Future research should focus on biological and molecular mechanisms underlying these associations, with the hope of reducing the incidence of sepsis and sepsis-associated mortality. Citation Format: Yurii B. Shvetsov, Mari Ogino, Chloe Asato, Lynne R. Wilkens, Loic LeMarchand, Michelle Matter. Association of cancer site and treatment type with the risk of sepsis-related mortality in a multiethnic Hawaii population [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5794.