Risk for Hospitalization With Depression After a Cancer Diagnosis: A Nationwide, Population-Based Study of Cancer Patients in Denmark From 1973 to 2003

2009 ◽  
Vol 27 (9) ◽  
pp. 1440-1445 ◽  
Author(s):  
Susanne O. Dalton ◽  
Thomas Munk Laursen ◽  
Lone Ross ◽  
Preben Bo Mortensen ◽  
Christoffer Johansen
Keyword(s):  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Early Recognition ◽  
Population Based ◽  
First Year ◽  
Central Register ◽  
Increased Risk ◽  
Diagnosis Of Cancer ◽  
Long Term Impact ◽  
Risk For Depression

Purpose As more people survive cancer, it is necessary to understand the long-term impact of cancer. We investigated whether cancer survivors are at increased risk for hospitalization for depression. Methods We linked data on all 5,703,754 persons living in Denmark on January 1, 1973, or born thereafter to the Danish Cancer Registry and identified 608,591 adults with a diagnosis of cancer. Follow-up for hospitalization for depression in the Danish Psychiatric Central Register from 1973 through 2003 yielded 121,227,396 person-years and 121,304 hospitalizations for depression. The relative risk (RR) for depression among cancer survivors relative to the cancer-free population was estimated by Poisson regression analysis with adjustment for age and period and stratified by sex, site of cancer, and extent of disease. Results The risk for depression in the first year after a cancer diagnosis was increased, with RRs ranging from 1.16 (95% CI, 0.90 to 1.51) in women with colorectal cancer to 3.08 (95% CI, 1.88 to 5.02) in men with brain cancer. Decreasing but still significant excess risks during subsequent years were observed for most specific cancers. The risk remained increased throughout the study period for both men and women surviving hormone-related cancers, for women surviving smoking-related cancers, and for men surviving virus- and immune-related cancers. Conclusion This study confirms an increased risk for depression in patients facing a disruptive event like cancer. Early recognition and effective treatment are needed to prevent admission of cancer survivors for depression.

Incidence of acute kidney injury in cancer patients: A population-based cohort study in Denmark

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9570-9570
Author(s):  
C. F. Christiansen ◽  
M. B. Johansen ◽  
S. Christensen ◽  
W. Langeberg ◽  
J. P. Fryzek ◽  
...  
Keyword(s):  
At Risk ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Kidney Injury ◽  
Population Based ◽  
First Year ◽  
Increased Risk

9570 Background: Although cancer patients may be at increased risk for acute kidney injury (AKI), which could then reduce their likelihood of receiving optimal therapeutic management and supportive care, the occurrence of AKI among newly diagnosed cancer patients has not been well-described. Therefore, we examined the incidence of AKI within the first year after cancer diagnosis to estimate the magnitude of this risk and better understand which patients are at greatest risk. Methods: Using the population-based Danish Cancer Registry, we conducted a retrospective cohort study of 4,427 men and women from North Jutland, Denmark (population 500,000) diagnosed with cancer from 2002 to 2003 (non-melanoma skin cancer excluded). AKI was defined according to the Risk/ Injury/ Failure/ Loss/ End-stage-renal-disease (RIFLE) criteria. We included Risk or worse: at least a 1.5 times increase in serum creatinine (sCr) from baseline. SCr levels were obtained from the Regional Laboratory Database, which collects all biochemical analyses for hospital laboratories. Baseline sCr was defined as the lowest sCr in the year before cancer diagnosis. We compared this value to the highest sCr on record during the first year following cancer diagnosis to identify those who experienced an AKI. Results: Median age for the cohort was 68.6 years, 50.9% were men, and the most common cancer sites were lung (14.2%), breast (13.7%), prostate (9.8%), colon (9.6%), rectum (5.1%), and bladder (6.3%). During the first year, 973 (22.0%) members of the cohort experienced an AKI, corresponding to an overall incidence rate of 326 per 1,000 person-years (95% confidence interval (CI) 306–347). Incidence was highest among patients aged 80 years or older (531 per 1,000 person-years, 95% CI 464–606) and in those with cancer of the liver (1,221, 95%CI 676–2,205), pancreas (1,472, 95%CI 1,130–1,917), or kidney (1,254, 95%CI 974–1,616), or with multiple myeloma (855, 95%CI 538–1,356). Conclusions: To protect against AKI, we must first identify those at risk. Our study showed that over 20% of cancer patients may experience acute kidney injury in the first year after diagnosis. Older patients and those with cancer of the liver, pancreas, or kidney, or with multiple myeloma are especially at risk for AKI. [Table: see text]

Increased Risk for Depression After Breast Cancer: A Nationwide Population-Based Cohort Study of Associated Factors in Denmark, 1998-2011

2014 ◽  
Vol 32 (34) ◽  
pp. 3831-3839 ◽  
Author(s):  
Nis P. Suppli ◽  
Christoffer Johansen ◽  
Jane Christensen ◽  
Lars V. Kessing ◽  
Niels Kroman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Population Based ◽  
First Year ◽  
Node Positive ◽  
Increased Risk ◽  
Node Positive Disease ◽  
Rate Ratios ◽  
Hospital Contact ◽  
Risk For Depression

Purpose To investigate the risk for first depression, assessed as incident hospital contacts for depression and incident use of antidepressants, among women with breast cancer. Patients and Methods Danish national registries were used to identify 1,997,669 women with no diagnosis of cancer or a major psychiatric disorder. This cohort was followed from 1998 to 2011 for a diagnosis of breast cancer and for the two outcomes, hospital contact for depression and redeemed prescriptions for antidepressants. Rate ratios for incident hospital contacts for depression and incident use of antidepressants were estimated with Poisson regression models. Multivariable Cox regression was used to evaluate factors associated with the two outcomes among patients with breast cancer. Results We identified 44,494 women with breast cancer. In the first year after diagnosis, the rate ratio for a hospital contact for depression was 1.70 (95% CI 1.41 to 2.05) and that for use of antidepressants was 3.09 (95% CI 2.95 to 3.22); these rate ratios were significantly increased after 3 and 8 years, respectively. Comorbidity, node-positive disease, older age, basic and vocational educational levels, and living alone were associated with use of antidepressants. Conclusion Women with breast cancer are at long-term increased risk for first depression, including both severe episodes leading to hospital contact and use of antidepressants. Clinicians should be aware that the risk is highest in women with comorbid conditions, node-positive disease, and age of 70 years or more. We found no clear association between type of surgery or adjuvant treatment and risk for depression.

scholarly journals Increased Risk of Suicide among Cancer Survivors Who Developed a Second Malignant Neoplasm

2022 ◽  
Vol 2022 ◽  
pp. 1-11
Author(s):  
Huazhen Yang ◽  
Yuanyuan Qu ◽  
Yanan Shang ◽  
Chengshi Wang ◽  
Junren Wang ◽  
...  
Keyword(s):  
General Population ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Malignant Neoplasm ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Second Malignant Neoplasm ◽  
Suicide Death ◽  
Increased Risk ◽  
Standardized Mortality Ratios

Background. Cancer diagnosis entails substantial psychological distress and is associated with dramatically increased risks of suicidal behaviors. However, little is known about the suicide risk among cancer survivors who developed a second malignant neoplasm (SMN). Methods. Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study involving 7,824,709 patients with first malignant neoplasm (FMN). We measured the hazard ratios (HRs) of suicide death after receiving a SMN diagnosis using Cox proportional hazard models, as compared with patients with FMN. The comparison with the US population was achieved by calculating standardized mortality ratios (SMRs). Results. Totally 685,727 FMN patients received a diagnosis of SMN during follow-up, and we in total identified 10,930 and 937 suicide deaths among FMN and SMN patients, respectively. The HR of suicide deaths was 1.23 (95% confidence interval (CI), 1.14–1.31) after a SMN diagnosis, compared with FMN patients, after adjusting for sociodemographic factors, tumor characteristics, and cancer treatment. As compared with the general population, while both SMN and FMN patients suffered an increased risk of suicide deaths, the excess risk was higher among SMN patients than FMN patients (age-, sex-, and calendar-year-adjusted SMR 1.65 (95% CI 1.54–1.75) vs. 1.29 (95% CI 1.26–1.31); P difference < 0.0001 ). Notably, across different time periods, we observed the greatest risk elevation during the first 3 months after a cancer diagnosis. Conclusions. Compared with either patients with FMN or the general population, cancer survivors who received a SMN diagnosis were at increased risk of suicide death. The risk elevation was most prominent soon after the cancer diagnosis, highlighting the necessity of providing timely psychological support to cancer survivors with a SMN.

Pregnancy outcome and survivorship in cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1503-1503 ◽  
Author(s):  
Nir Pillar ◽  
Shali Mazaki-Tovi ◽  
Raanan Berger ◽  
Shani Paluch-Shimon ◽  
Zvi Symon ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Pregnant Women ◽  
Cancer Patients ◽  
Pregnancy Outcome ◽  
Cancer Diagnosis ◽  
Large Scale ◽  
Obstetric Complications ◽  
Childbearing Age ◽  
Increased Risk ◽  
Diagnosis Of Cancer

1503 Background: Advances in cancer detection and treatment have resulted in increased prevalence of female cancer survivors at childbearing age. While the association between cancer treatment and fertility has been thoroughly investigated, data regarding pregnancy outcome of cancer survivor are scarce. The aim of this study is to determine whether cancer survivors and sufferers have increased risk of obstetric complications. Methods: A population-based cohort study using data from the NIS of the Healthcare Cost and Utilization Project, focusing on 2000-2006. The rate of maternal and fetal obstetric complications was determined in pregnant women with and without diagnosis of cancer. Results: A total of 6,732,293 births were included in the analysis, of these 15,191 had maternal cancer diagnosis (0.2%). Pregnant women with cancer diagnosis had increased risk for premature labor, ectopic pregnancy, and need for blood transfusion. Moreover, the rate of maternal (3.6/ 1000 births) and fetal (8.3/1000 births) mortality was higher amongst women with cancer compared to non-cancer bearing women- (0.12/ 1000 births) and (3.9/ 1000 births) respectively. Multivariate logistic regression revealed that both age and cancer diagnosis were significantly and independently associated with pregnancy complications. Conclusions: This is the first large-scale study to determine the prevalence of obstetric complications in cancer patients. Pregnant women with a diagnosis of cancer are at increased risk of major obstetric complications, including maternal and fetal death, although the absolute risk is relatively low. It may therefore be prudent to define such pregnancies as “high-risk” and advocate intense prenatal care for these patients. [Table: see text]

scholarly journals Su1228 Increased Risk of Colorectal Cancer in Patients With Prior Ovarian Cancer Diagnosis: A Population Based US Study

2014 ◽  
Vol 146 (5) ◽  
pp. S-408
Author(s):  
Yezaz A. Ghouri ◽  
Sachin Batra ◽  
Nirav C. Thosani ◽  
Sushovan Guha
Keyword(s):  
Colorectal Cancer ◽  
Ovarian Cancer ◽  
Cancer Diagnosis ◽  
Population Based ◽  
Increased Risk

scholarly journals Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan

2018 ◽  
Vol 53 ◽  
pp. 7-16 ◽  
Author(s):  
Ching-En Lin ◽  
Chi-Hsiang Chung ◽  
Li-Fen Chen ◽  
Mei-Ju Chi
Keyword(s):  
Antipsychotic Agents ◽  
Population Based ◽  
Competing Risk ◽  
First Year ◽  
Traumatic Head Injury ◽  
Chronic Lung Diseases ◽  
Dementia Risk ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Persons With Schizophrenia

AbstractBackground:The extent to which schizophrenia is associated with the risk of all-cause dementia is controversial. This study investigated the risk of dementia by type in patients with schizophrenia.Methods:Data were collected from the Taiwanese National Health Insurance Database 2005 and analyzed using multivariate Cox proportional hazard regression models to determine the effect of schizophrenia on the dementia risk after adjusting for demographic characteristics, comorbidities, and medications. Fine and Gray's competing risk analysis was used to determine the risk of dementia, as death can act as a competing risk factor for dementia.Results:We assessed 6040 schizophrenia patients and 24,160 propensity scale-matched control patients. Schizophrenia patients exhibited a 1.80-fold risk of dementia compared to controls (adjusted hazard ratio [aHR] = 1.80, 95% confidence interval [CI] = 1.36 ∼ 2.21,p <0.001) after adjusting for covariates. Cardiovascular disease (aHR = 5.26; 95% CI = 4.50 ∼ 6.72;p <0.001), hypertension (aHR = 1.83; 95% CI = 1.77 ∼ 2.04;p= 0.002), traumatic head injury (aHR = 1.35; 95% CI = 1.24 ∼ 1.78;p <0.001), chronic lung diseases (aHR = 1.64; 95% CI = 1.13 ∼ 2.56;p <0.001), alcohol-related disorders (aHR = 3.67; 95% CI = 2.68 ∼ 4.92;p <0.001), and Parkinson’s disease (aHR = 1.72; 95% CI = 1.25 ∼ 2.40;p <0.001) were significantly associated with dementia risk. Notably, first-generation antipsychotics (aHR = 0.80; 95% CI = 0.56 ∼ 0.95;p=0.044) and second-generation antipsychotics (aHR = 0.24; 95% CI = 0.11 ∼ 0.60;p <0.001) were associated with a lower dementia risk. Sensitivity tests yielded consistent findings after excluding the first year and first 3 years of observation. Patients with schizophrenia had the highest risk of developing Alzheimer’s [dementia/disease?] among dementia subtypes (aHR = 2.10; 95% CI = 1.88 ∼ 3.86;p< 0.001), followed by vascular dementia (aHR = 1.67; 95% CI = 1.27 ∼ 2.12;p< 0.001) and unspecified dementia (aHR = 1.30; 95% CI = 1.04 ∼ 2.01;p< 0.001).Conclusions:Schizophrenia was significantly associated with the risk of all-cause dementia. Data are scarce on the mechanisms through which antipsychotic agents protect persons with schizophrenia from developing dementia. Further research is recommended to elucidate the neurobiological mechanisms underlying the association between schizophrenia and dementia, and whether antipsychotics protect against the development of dementia in schizophrenia.

Genetic and treatment risks for diabetes mellitus (DM) in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS) and St. Jude Lifetime (SJLIFE) cohorts.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10014-10014
Author(s):  
Melissa A. Richard ◽  
Sogol Mostoufi-Moab ◽  
Nisha Rathore ◽  
Austin L. Brown ◽  
Stephen J. Chanock ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Regulatory Region ◽  
Childhood Cancer Survivors ◽  
Population Based ◽  
European Ancestry ◽  
Radiation Group ◽  
Increased Risk

10014 Background: Childhood cancer survivors face increased risk for DM, a polygenic trait also attributable to cancer treatment exposures, particularly abdominal radiation. We aimed to characterize the role of genetic and treatment risk factors for DM among two large cohorts of childhood cancer survivors. Methods: We performed a nested case-control genome-wide association study for DM managed with oral medications in the original CCSS cohort (diagnosed 1970-1986). Logistic regression was conducted in the total sample (N = 5083) and stratified by 1) European ancestry (EA) and 2) abdominal radiation. Replication of suggestive variants (P < 1×10-7) using Fisher’s exact test was performed in independent cohorts: i) CCSS expansion diagnosed 1987-1999 (N = 2588) and ii) SJLIFE diagnosed 1962-2012 (N = 2182). To evaluate the effect of cancer treatment on the background genetic predisposition to DM, we estimated standardized effect sizes (Z’) among EA survivors in each abdominal radiation group for 398 index variants from the largest population-based EA DM study. Radiation group Z’ estimates were compared using linear regression. Results: In the original CCSS cohort we identified nine variants associated with DM and provide further support for four linked variants in the ERCC6L2 locus. Among all survivors, the rs55849673-A allele was associated with increased odds for DM among survivors in the original CCSS cohort (minor allele frequency [MAF]-cases = 0.055; MAF-controls = 0.024; adjusted odds ratio [aOR] = 2.9, 95% CI: 2.0-4.2, P = 3.7×10-8). Allele frequencies were consistent in the CCSS expansion (MAF-cases = 0.075; MAF-controls = 0.028; P = 0.07) and SJLIFE (MAF-cases = 0.036; MAF-controls = 0.027; P = 0.5). Additionally, rs55849673-A estimates were consistent among EA survivors and stronger among survivors not treated with abdominal radiation (MAF-cases = 0.052; MAF-controls = 0.021; aOR = 3.6, P = 1.6×10-6). Notably, in the CCSS expansion all rs55849673-A EA carriers who developed DM did not receive abdominal radiation (MAF-cases = 0.1; MAF-controls = 0.026; P = 0.04). More broadly, the Z’ of population-based DM index variants were 78% lower in survivors treated with abdominal radiation than survivors not treated with abdominal radiation (beta = 0.22; P = 0.01), indicating the background genetic risk for DM may be altered by treatment. Conclusions: We provide evidence for a novel locus of DM in childhood cancer survivors. This locus is a regulatory region associated with expression of ERCC6L2, a gene implicated in an East Asian population-based DM study. Taken together, our findings support the overwhelming effect of abdominal radiation on DM risk in childhood cancer survivors, relative to other risk factors, and provide insight on a genetic locus that may be useful for DM risk prediction in the context of cancer treatment.

Peripheral Neuropathy in MGUS and Progression to Amyloid Light-Chain Amyloidosis: A Population-Based Study Including 15,351 MGUS Cases

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5444-5444
Author(s):  
Sæmundur Rögnvaldsson ◽  
Ingemar Turesson ◽  
Magnus Björkholm ◽  
Ola Landgren ◽  
Sigurður Yngvi Kristinsson
Keyword(s):  
Board Of Directors ◽  
Research Funding ◽  
Large Population ◽  
Diagnostic Delay ◽  
Population Based ◽  
Lymphoproliferative Disorders ◽  
First Year ◽  
Advisory Committees ◽  
Population Based Study ◽  
Increased Risk

Introduction Peripheral neuropathy (PN) is a common disorder that can be caused by amyloid light-chain amyloidosis (AL). AL is a rare disorder caused by the deposition of amyloid fibers, originating from malignant plasma cells. Amyloid deposition in peripheral nerves causes PN and is present in 35% of patients with newly diagnosed AL. Diagnosis of AL can be difficult, leading to under-recognition, diagnostic delay, and delayed treatment. Virtually all instances of AL are preceded by monoclonal gammopathy of undetermined significance (MGUS). MGUS is relatively common with a reported prevalence of 4.2% in the general Caucasian population over the age of 50 years. Although MGUS is usually considered asymptomatic, a significant proportion of affected individuals develop PN. However, we are not aware of any studies assessing how PN affects risk of MGUS progression to AL. We were therefore motivated to conduct a large population-based study including 15,351 Swedish individuals with MGUS diagnosed 1986-2013. Methods Participants diagnosed with MGUS between 1986-2013 were recruited from a registry of a nationwide network of hematology- and oncology centers and the Swedish Patient Registry. We then cross-linked data on recorded diagnoses of AL and PN from the Swedish Patient Registry, diagnoses of lymphoproliferative disorders form the Swedish Cancer Registry, and dates of death from the Cause of Death Registry to our study cohort. Individuals with a previous history of other lymphoproliferative disorders were excluded from the study. A multi-state survival model was created. At inclusion, participants started providing person time into the PN or the non-PN states depending on whether they had a previous diagnosis of PN. Those with MGUS who developed PN after inclusion were included into the PN state at the time of PN diagnosis and provided person time in the PN state after that. We then created a Cox proportional hazard regression model with AL as the endpoint. Participants were censored at diagnosis of other lymphoproliferative disorders. We adjusted for sex, age, and year of MGUS diagnosis. Results We included 15,351 participants with MGUS. Of those, 996 participants provided person-time with PN (6.5%). About half of those had PN at MGUS diagnosis (55%). A total of 174 cases of AL were recorded, with AL being more common among those who had PN (2.1% vs 1.0% p=0.002). Those who had PN had a 2.3-fold increased risk of AL as compared to those who did not have PN (hazard ratio (HR): 2.3; 95% confidence interval (95% CI): 1.5-3.7; p<0.001). The results were similar for those who had PN at MGUS diagnosis and those who did not. More than half of AL cases (53%) were diagnosed within one year after MGUS diagnosis. The rate was even higher among those with PN, with 82% of AL cases among those who presented with PN being diagnosed within one year after MGUS diagnosis. In the first year after inclusion, the incidence of AL was 15.2 and 6.1 per 1000 person-years for participants with and without PN respectively (HR: 1.8; 95% CI:1.0-3.4; p=0.04). Participants with PN continued to have an increased risk of progression to AL after the first year with an incidence of AL of 2.6 per 1000 person-years as compared to 1.1 per 1000 person-years among participants who did not have PN (HR:2.4; 95% CI: 1.1-5.0; p=0.02) (Figure). Discussion In this large population-based study, including 15,351 individuals with MGUS, we found that individuals with MGUS who develop PN have an increased risk of progression to AL. In fact, individuals with MGUS who have PN at MGUS diagnosis might already have AL. This risk of AL was highest during the first year after MGUS diagnosis with participants with PN having a higher risk than those who did not have PN. PN continued to be associated with a higher risk of MGUS progression to AL throughout the study period. This is the largest study that we are aware of assessing the association of PN and MGUS progression to AL. Since this is a registry-based study based on recorded diagnoses, some clinical data, including MGUS isotype, is not available. These findings suggest that increased awareness of PN as a feature of MGUS might decrease diagnostic delay and improve outcomes for patients with AL. Figure Disclosures Landgren: Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Theradex: Other: IDMC; Adaptive: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Other: IDMC; Abbvie: Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharm: Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Multiple Myeloma and Infections: A Population-Based Study Based On 9,610 Multiple Myeloma Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 945-945
Author(s):  
Cecilie Blimark ◽  
Ulf-Henrik Mellqvist ◽  
Ola Landgren ◽  
Magnus Björkholm ◽  
Malin L Hultcrantz ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Normal Population ◽  
Large Population ◽  
Population Based ◽  
First Year ◽  
Population Based Study ◽  
Prophylactic Measures ◽  
Increased Risk

Abstract Abstract 945 Background Infections are a major cause of morbidity and mortality in patients with multiple myeloma (MM). No large population-based evaluation has been made to assess the risk of infections in MM patients compared to the normal population. Therefore, we performed a large study, using population-based data from Sweden, to estimate the risk of bacterial and viral infections among 9,610 MM patients compared to 37,718 matched controls. Methods We gathered information on all MM patients reported to the nationwide Swedish Cancer Registry from 1988 to 2004, with follow-up to 2007. For each MM patient, four population-based controls (matched by age, sex, and county of residence) were identified randomly from the Swedish population database. Information on occurrence and date of infections was obtained from the centralized Swedish Patient registry that captures information on individual patient-based discharge diagnosis from inpatient (with very high coverage) and outpatient care (since 2000). Cox proportional hazard models were used to estimate the overall, one- and five-year risk of infections. In addition, the effect of gender, age and calendar period of diagnosis was evaluated. Hazard ratios (HRs) and confidence intervals (CIs) were calculated for the occurrence of different infections. Results Overall, MM patients had a 6-fold (HR= 5.9; 95% CI=5.7-6.1) risk of developing any infection compared to matched controls (Figure). The increased risk of developing a bacterial infection was 6-fold (HR=5.9; 95%; CI=5.6-6.1), and for viral infections 9-fold (HR=9.0; 95% CI=8.0-10.1), compared to controls. More specifically, MM patients had an increased risk (p<0.05) of the following bacterial infections: cellulitis (HR=2.6; 95% CI =2.2-3.1), osteomyelitis (HR=3.0; 95% CI 2.0–4.4), endocarditis (HR=4.4; 95% CI 2.9–6.6), meningitis (HR=14.5; 95% CI 9.1–23.0), pneumonia (HR=6.2; 95% CI 5.9–6.5), pyelonephritis (HR=2.5; 95% CI 2.1–3.0), and septicaemia (HR=13.7; 95% CI 12.5–14.9) and for the viral infections influenza (HR=5.4; 95% CI 4.4–6.7) and herpes zoster (HR=12.8; 95% CI 10.5–15.5). The risk of infections was highest during the first year after diagnosis; the risk of bacterial infections was 11-fold (95% CI 10.7–12.9) and the risk of viral infections was 18-fold (95% CI 13.5–24.4) higher compared to controls during the first year after diagnosis. MM patients diagnosed in the more recent calendar periods had significantly higher risk of infections, reflected in a 1.6-fold (95% CI=1.5-1.7) and 2-fold (95% CI=1.9-2.1) increased risk in patients diagnosed during 1994–1999 and 2000–2004, compared to patients diagnosed 1986–1993. Females had a significantly lower risk of infections compared to males (p<0.001). Increasing age was significantly associated with a higher risk of infections (p<0.001). Discussion In this large population-based study including over 9,000 MM patients and 35,000 matched controls, we found that bacterial and viral infections represent a major threat to myeloma patients. We found the risk of specific infections like pneumonia, and septicemia to be over ten times higher in patients than in controls during the first year after MM diagnosis. Importantly, the risk of infections increased in more recent years. The effect on infectious complications due to novel drugs in the treatment of MM needs to be established and trials on prophylactic measures are required. Disclosures: Mellqvist: Janssen, Celgene: Honoraria.

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