Abstract
Background and Objective:Cancer is a known risk factor for developing active tuberculosis (TB) disease. The incidence of and risk factors for TB are not known among cancer patients in Thailand. This study aimed to investigate risk factors for TB among cancer patients in an area with endemic TB infections. Methods:We used the Khon Kaen population–based cancer registry and two TB databases to conduct a retrospective cohort study of cancer patients. From 2001 to 2015, we identified 40,948 eligible cancer patients. Following until 2017, we identified cases of TB diagnosed after cancer diagnosis and analyzed primary cancer site, staging, treatment, and demographic factors. Adjusted incidence rate ratios (adj. IRR) were computed to identify risk factors among a sub–set of cancer types (n = 9,733) using Poisson regression. Results:Among all cancer patients, 472 cases of TB were diagnosed following cancer diagnosis (cumulative incidence = 1.15%, incidence rate = 421.86 cases per 100,000 patients per year). Among the sub–set of cancer types, 206 cases of TB were found (cumulative incidence = 2.11%, incidence rate = 848.26 cases per 100,000 patients per year). Risk factors for TB among cancer patients were sex (p < 0.001) (male adj. IRR = 1.87, 95% CI: 1.36–2.59), age (p < 0.001) (age >70 adj. IRR = 2.36, 95% CI: 1.56-3.55, compared to age ≤50) and cancer site (p < 0.001). Compared to thyroid cancer, TB infection was more associated with lung cancer without histopathological confirmation (adj. IRR = 6.22, 95% CI: 2.57–15.04). Cancer stage and treatment did not show statistically significant trends. Conclusion:Old age, male sex, and certain cancer types were independent risk factors for TB in cancer patients. Targeted latent TB screening may be appropriate among high risk groups.
Highlights
Cancer is a major public health problem worldwide and among the most common causes of morbidity and mortality
The incidence of and risk factors for TB are not known among cancer patients in Thailand
Following until 2017, we identified cases of TB diagnosed after cancer diagnosis and analyzed primary cancer site, staging, treatment, and demographic factors
Summary
Cancer is a major public health problem worldwide and among the most common causes of morbidity and mortality. The treatment of cancer, especially chemotherapy, plays an important role in immunosuppression This leads to an increased risk of reactivating latent tuberculosis (TB) infections or new TB infection during the clinical course of cancer in endemic areas of the disease. The purpose of this study was to use a regional population–based cohort of cancer patients to analyze this issue and identify groups at higher risk of TB infection. IRR) were computed to identify risk factors among a sub–set of cancer types (n = 9,733) using Poisson regression. Among the sub–set of cancer types, 206 cases of TB were found (cumulative incidence = 2.11%, incidence rate = 848.26 cases per 100,000 patients per year). Risk factors for TB among cancer patients were sex (p < 0.001) Conclusion: Old age, male sex, and certain cancer types were independent risk factors for TB in cancer patients. Targeted latent TB screening may be appropriate among high risk groups
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