Abstract
Background: Cancer survivors are at increased risk of sepsis, possibly attributed to weakened physiologic conditions. The aims of this study were to examine the mediation effect of indicators of frailty on the association between cancer survivorship and sepsis incidence and whether these differences varied by race. Methods: We performed a prospective analysis using data from the REasons for Geographic and Racial Differences in Stroke cohort from years 2003 to 2012. We categorized frailty as the presence of ≥2 frailty components (weakness, exhaustion, and low physical activity). We categorized participants as “cancer survivors” or “no cancer history” derived from self-reported responses of being diagnosed with any cancer. We examined the mediation effect of frailty on the association between cancer survivorship and sepsis incidence using Cox regression. We repeated analysis stratified by race. Results: Among 28 062 eligible participants, 2773 (9.88%) were cancer survivors and 25 289 (90.03%) were no cancer history participants. Among a total 1315 sepsis cases, cancer survivors were more likely to develop sepsis (12.66% vs 3.81%, P <.01) when compared to participants with no cancer history (hazard ratios: 2.62, 95% confidence interval: 2.31-2.98, P <.01). The mediation effects of frailty on the log-hazard scale were very small: weakness (0.57%), exhaustion (0.31%), low physical activity (0.20%), frailty (0.75%), and total number of frailty indicators (0.69%). Similar results were observed when stratified by race. Conclusion: Cancer survivors had more than a 2-fold increased risk of sepsis, and indicators of frailty contributed to less than 1% of this disparity.
| Original language | English |
|---|---|
| Pages (from-to) | 708-719 |
| Number of pages | 12 |
| Journal | Journal of Intensive Care Medicine |
| Volume | 35 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2020 |
Bibliographical note
Publisher Copyright:© The Author(s) 2018.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Justin Xavier Moore received grant support from (grant R25 CA47888) the Cancer Prevention and Control Training Program, funded by the National Cancer Institute, National Institutes of Health. Dr Justin Xavier Moore was additionally supported by grant T32190194 from the National Cancer Institute (Colditz) and by the foundation for Barnes Jewish Hospital and by Siteman Cancer Center. This work was supported by award (grant number R01-NR012726) from the National Institute for Nursing Research, from the National Center for Research Resources (grant number UL1-RR025777), as well as by grants from the Center for Clinical and Translational Science and the Lister Hill Center for Health Policy of the University of Alabama at Birmingham. The parent REGARDS study was supported by cooperative agreement (grant number U01-NS041588) from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, and Department of Health and Human Service. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Representatives of the funding agencies have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data.
| Funders | Funder number |
|---|---|
| National Institutes of Health (NIH) | T32190194 |
| National Institutes of Health (NIH) | |
| U.S. Department of Health and Human Services | |
| National Childhood Cancer Registry – National Cancer Institute | |
| National Institute of Health National Institute of Nursing Research | |
| Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council | |
| National Center for Research Resources | UL1RR025777 |
| National Center for Research Resources | |
| Foundation for Barnes-Jewish Hospital | |
| Center for Clinical and Translational Science, University of Illinois at Chicago | |
| University of Alabama | U01-NS041588 |
| University of Alabama | |
| Alvin J. Siteman National Cancer Institute Comprehensive Cancer Center | R01-NR012726 |
| Alvin J. Siteman National Cancer Institute Comprehensive Cancer Center |
Keywords
- Cancer
- Frailty
- Mediation
- Sepsis
- and Racial Disparities
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
