2826 Trends of Sepsis Mortality in Colon Cancer Patients

Abstract

INTRODUCTION: Investigations have revealed that 1 in 6 severe sepsis patients have underlying neoplastic disease. Cancer patients have been shown to be nearly 10 times more likely to acquire sepsis than the noncancer US population. Moreover, this patient population was also shown to have a 30% higher risk of mortality compared with other severe sepsis patients (1, 2). We utilize a national database - Surveillance, Epidemiology, and End Results (SEER) - to analyze and elucidate trends in sepsis mortality over the years in patients diagnosed with colon cancer. METHODS: Incidence data was derived from the 9 original registries of the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer. 10% of US population was accounted for under the 9 original SEER registries. (3) Cancer incidences were collected from 1985 to December 31, 2014. Septicemia was chosen as the end point for our patient population. SEER data of death events occurring from 1/1/1985-12/31/2014 were used in change point analysis. We fitted the two-piece linear trend line with jump located at each year in 1990 to 2010. Root-mean-square error (RMSE) was obtained for each trend line. Year of jump was determined by choosing the trend line with smallest RMSE. RESULTS: In 1985 to 2014, a total of 185,582 deaths were recorded in patients diagnosed with primary colon malignancies. Septicemia was listed as the cause of death for 1,517 of these patients. When assessing temporal changes in sepsis mortality, a statistically significant change in trend was seen in the year 1999 across the colon cancer cohort (+0.39%, P < 0.001). CONCLUSION: There was a statistically significant increase in the ratio of sepsis deaths to total deaths in patients with colon cancer in 1999. It is difficult to declare at this point one single reason for this trend, however the authors believe it could in large part be attributed to earlier diagnosis of colon cancer, and thus an apparent prolonged duration of life. Interestingly, in 1998, Medicare began to cover colon cancer screening via fecal occult blood testing (FOBT) and sigmoidoscopy. In mid-2001, universal coverage was advanced to screening colonoscopy. 1) Martin GS et al. The Epidemiology of Sepsis in the United States from 1979 through 2000. The New England Journal of Medicine. 2003;348(16):1546-54. 2) Danai PA et al. The Epidemiology of Sepsis in Patients With Malignancy. Chest. 2006;129(6):1432-40.