Survivors of childhood cancer have an increased risk of infections related to hospitalization, according to a study published in the Journal of Clinical Oncology

When compared with patients who did not have cancer, childhood cancer survivors had a greater risk of inpatient infections 5 years or more after their cancer diagnosis.

To investigate the risk of inpatient infection among childhood cancer survivors, researchers analyzed data from children and adolescents born in Washington State. 

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The cancer survivor cohort included 3152 patients diagnosed with cancer before age 20 who had survived at least 5 years after diagnosis. Patients had survived solid tumors (60.5%) or hematologic malignancies (39.5%). 

The cancer survivors were matched by birth year and sex with 31,519 individuals who did not have cancer. 

The primary outcome was the incidence of any infection associated with a hospitalization occurring 5 or more years after the cancer diagnosis, through December 2013.

Overall, there were 382 inpatient infections in the cancer survivors and 771 inpatient infections in the comparators. 

The incidence rate (IR) was 12.6 inpatient infections per 1000 person-years for cancer survivors, and the IR was 2.4 inpatient infections per 1000 person-years for the comparators. The IR for inpatient infections was higher for survivors of hematologic cancers than for survivors of solid tumor malignancies — 18.5 and 8.7, respectively.

Bacterial was the most common infection type in survivors of hematologic malignancies (IR, 7.3) and non-hematologic malignancies (IR, 2.7). By organ system, respiratory infections were the most common in survivors of hematologic malignancies (IR, 4.1). Survivors of solid tumor malignancies had a similar incidence of genitourinary and respiratory infections (IR, 2.6 for both). 

The incidence of inpatient infections declined over time for the cancer survivors. The IR was 18.1 for the 5- to 10-year period after diagnosis and 8.3 beyond 10 years. Both IRs were greater than the IRs for the comparison group, which were 2.3 and 2.5, respectively. 

When the researchers looked at potentially vaccine-preventable infections, cancer survivors had a greater risk of infection relative to comparators (incidence rate ratio, 13.1). 

“Varicella zoster virus was the most common vaccine-preventable illness reported, followed by influenza,” the researchers wrote. “It is important to note, however, that many of these patients (approximately 70%) were born before incorporation of the varicella vaccine into the routine childhood vaccination series, and thus may not represent a failure of prior vaccine receipt.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

ReferenceChehab L, Doody DR, Esbenshade AJ, et al. A population-based study of the long-term risk of infections associated with hospitalization in childhood cancer survivors. J Clin Oncol. Published online July 25 2022. doi:10.1200/JCO.22.00230