Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database

Kristian Hastoft Jensen; Ivan Vogelius; Claus Ernst Moser; Elo Andersen; Jesper Grau Eriksen; Jørgen Johansen; Mohammad Farhadi; Maria Andersen; Jens Overgaard; Jeppe Friborg

doi:10.1038/s41416-021-01430-w

Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database

Kristian Hastoft Jensen^*, Ivan Vogelius, Claus Ernst Moser, Elo Andersen, Jesper Grau Eriksen, Jørgen Johansen, Mohammad Farhadi, Maria Andersen, Jens Overgaard, Jeppe Friborg

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Background: Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy (RT) or chemoradiation (CRT) may become immunocompromised. In this population-based study, we aimed to investigate the risk factors, microbiological aetiologies, prognosis and impact on early non-cancer mortality of bloodstream infections (BSIs) after RT/CRT. Methods: Patients with HNSCC of the pharynx, larynx and oral cavity treated with curative-intent RT/CRT in Denmark between 2010 and 2017 and subsequent BSI episodes occurring within 18 months of RT/CRT initiation were identified in national registries. Results: We included 5674 patients and observed 238 BSIs. Increasing age, stage and performance status were significantly associated with an elevated BSI risk, while sex, smoking and high-grade mucositis were not. Human papillomavirus-positive oropharyngeal cancer patients had a decreased risk. Staphylococcus aureus accounted for 34% of episodes occurring during the first 3 months. The 30-day post-BSI mortality rate was 26% (95% confidence interval: 19–32) and BSIs were involved in 10% of early non-cancer deaths. Conclusion: The risk of BSI development is associated with several patient- and disease-related factors and BSIs contribute considerably to early non-cancer mortality. Empiric antibiotic treatment regimens should prioritise coverage for S. aureus when treating suspected systemic infection in this population.

Originalsprog	Engelsk
Tidsskrift	British Journal of Cancer
Vol/bind	125
Nummer	3
Sider (fra-til)	458-464
Antal sider	7
ISSN	0007-0920
DOI	https://doi.org/10.1038/s41416-021-01430-w
Status	Udgivet - aug. 2021

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10.1038/s41416-021-01430-w

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8329195/pdf/41416_2021_Article_1430.pdf

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Jensen, K. H., Vogelius, I., Moser, C. E., Andersen, E., Eriksen, J. G., Johansen, J., Farhadi, M., Andersen, M., Overgaard, J., & Friborg, J. (2021). Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database. British Journal of Cancer, 125(3), 458-464. https://doi.org/10.1038/s41416-021-01430-w

@article{e7faaba5536745118ae226157b9b7cac,

title = "Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database",

abstract = "Background: Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy (RT) or chemoradiation (CRT) may become immunocompromised. In this population-based study, we aimed to investigate the risk factors, microbiological aetiologies, prognosis and impact on early non-cancer mortality of bloodstream infections (BSIs) after RT/CRT. Methods: Patients with HNSCC of the pharynx, larynx and oral cavity treated with curative-intent RT/CRT in Denmark between 2010 and 2017 and subsequent BSI episodes occurring within 18 months of RT/CRT initiation were identified in national registries. Results: We included 5674 patients and observed 238 BSIs. Increasing age, stage and performance status were significantly associated with an elevated BSI risk, while sex, smoking and high-grade mucositis were not. Human papillomavirus-positive oropharyngeal cancer patients had a decreased risk. Staphylococcus aureus accounted for 34% of episodes occurring during the first 3 months. The 30-day post-BSI mortality rate was 26% (95% confidence interval: 19–32) and BSIs were involved in 10% of early non-cancer deaths. Conclusion: The risk of BSI development is associated with several patient- and disease-related factors and BSIs contribute considerably to early non-cancer mortality. Empiric antibiotic treatment regimens should prioritise coverage for S. aureus when treating suspected systemic infection in this population.",

keywords = "ACCELERATED RADIOTHERAPY, CARCINOMA, DAHANCA, MORTALITY, NIMORAZOLE",

author = "Jensen, {Kristian Hastoft} and Ivan Vogelius and Moser, {Claus Ernst} and Elo Andersen and Eriksen, {Jesper Grau} and J{\o}rgen Johansen and Mohammad Farhadi and Maria Andersen and Jens Overgaard and Jeppe Friborg",

note = "Funding Information: Funding information The study was funded by the Danish Comprehensive Cancer Center—Radiotherapy, the Faculty of Health Science at the University of Copenhagen, Varian Research Foundation, the Department of Oncology, Rigshos-pitalet, Copenhagen University Hospital, and the Dagmar Marshall, Einar Willumsen, Else & Mogens Wedell-Wedellsborg and A.P. Moller foundations. The funding sources had no influence on study conceptualisation, data gathering, data analysis or manuscript preparation. The study was supported by PERSIMUNE through grant number DNRF126. Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer Nature Limited.",

year = "2021",

month = aug,

doi = "10.1038/s41416-021-01430-w",

language = "English",

volume = "125",

pages = "458--464",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Nature Publishing Group",

number = "3",

}

Jensen, KH, Vogelius, I, Moser, CE, Andersen, E, Eriksen, JG, Johansen, J, Farhadi, M, Andersen, M, Overgaard, J & Friborg, J 2021, 'Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database', British Journal of Cancer, bind 125, nr. 3, s. 458-464. https://doi.org/10.1038/s41416-021-01430-w

Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database. / Jensen, Kristian Hastoft; Vogelius, Ivan; Moser, Claus Ernst et al.
I: British Journal of Cancer, Bind 125, Nr. 3, 08.2021, s. 458-464.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy

T2 - a population-based study from the Danish Head and Neck Cancer Group database

AU - Jensen, Kristian Hastoft

AU - Vogelius, Ivan

AU - Moser, Claus Ernst

AU - Andersen, Elo

AU - Eriksen, Jesper Grau

AU - Johansen, Jørgen

AU - Farhadi, Mohammad

AU - Andersen, Maria

AU - Overgaard, Jens

AU - Friborg, Jeppe

N1 - Funding Information: Funding information The study was funded by the Danish Comprehensive Cancer Center—Radiotherapy, the Faculty of Health Science at the University of Copenhagen, Varian Research Foundation, the Department of Oncology, Rigshos-pitalet, Copenhagen University Hospital, and the Dagmar Marshall, Einar Willumsen, Else & Mogens Wedell-Wedellsborg and A.P. Moller foundations. The funding sources had no influence on study conceptualisation, data gathering, data analysis or manuscript preparation. The study was supported by PERSIMUNE through grant number DNRF126. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Nature Limited.

PY - 2021/8

Y1 - 2021/8

N2 - Background: Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy (RT) or chemoradiation (CRT) may become immunocompromised. In this population-based study, we aimed to investigate the risk factors, microbiological aetiologies, prognosis and impact on early non-cancer mortality of bloodstream infections (BSIs) after RT/CRT. Methods: Patients with HNSCC of the pharynx, larynx and oral cavity treated with curative-intent RT/CRT in Denmark between 2010 and 2017 and subsequent BSI episodes occurring within 18 months of RT/CRT initiation were identified in national registries. Results: We included 5674 patients and observed 238 BSIs. Increasing age, stage and performance status were significantly associated with an elevated BSI risk, while sex, smoking and high-grade mucositis were not. Human papillomavirus-positive oropharyngeal cancer patients had a decreased risk. Staphylococcus aureus accounted for 34% of episodes occurring during the first 3 months. The 30-day post-BSI mortality rate was 26% (95% confidence interval: 19–32) and BSIs were involved in 10% of early non-cancer deaths. Conclusion: The risk of BSI development is associated with several patient- and disease-related factors and BSIs contribute considerably to early non-cancer mortality. Empiric antibiotic treatment regimens should prioritise coverage for S. aureus when treating suspected systemic infection in this population.

AB - Background: Patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy (RT) or chemoradiation (CRT) may become immunocompromised. In this population-based study, we aimed to investigate the risk factors, microbiological aetiologies, prognosis and impact on early non-cancer mortality of bloodstream infections (BSIs) after RT/CRT. Methods: Patients with HNSCC of the pharynx, larynx and oral cavity treated with curative-intent RT/CRT in Denmark between 2010 and 2017 and subsequent BSI episodes occurring within 18 months of RT/CRT initiation were identified in national registries. Results: We included 5674 patients and observed 238 BSIs. Increasing age, stage and performance status were significantly associated with an elevated BSI risk, while sex, smoking and high-grade mucositis were not. Human papillomavirus-positive oropharyngeal cancer patients had a decreased risk. Staphylococcus aureus accounted for 34% of episodes occurring during the first 3 months. The 30-day post-BSI mortality rate was 26% (95% confidence interval: 19–32) and BSIs were involved in 10% of early non-cancer deaths. Conclusion: The risk of BSI development is associated with several patient- and disease-related factors and BSIs contribute considerably to early non-cancer mortality. Empiric antibiotic treatment regimens should prioritise coverage for S. aureus when treating suspected systemic infection in this population.

KW - ACCELERATED RADIOTHERAPY

KW - CARCINOMA

KW - DAHANCA

KW - MORTALITY

KW - NIMORAZOLE

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U2 - 10.1038/s41416-021-01430-w

DO - 10.1038/s41416-021-01430-w

M3 - Journal article

C2 - 34017084

AN - SCOPUS:85105978114

SN - 0007-0920

VL - 125

SP - 458

EP - 464

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 3

ER -

Bloodstream infections in head and neck cancer patients after curative-intent radiotherapy: a population-based study from the Danish Head and Neck Cancer Group database

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