Patients with breast cancer and the threat of septicemia.

Abstract

e18622 Background: A very dangerous complication that can occur in breast cancer patients is septicemia. However, there are not many large scale studies that have demonstrated patient and hospital factors associated with higher risk of this complication in breast cancer patients. Methods: We utilized the 2006-2012 Nationwide Emergency Department Sample to identify breast cancer patients that presented to the emergency department (ED) with a primary diagnosis of septicemia. A multivariate logistic regression was used to identify characteristics that were significantly associated with a higher chance of septicemia. A p-value less than 0.05 was considered significant. Results: Between 2006 and 2012, 2,160,701 breast cancer patients presented to the ED. Out of these patients, 39,164 (1.8%) presented to the ED with a primary diagnosis of septicemia. Most patients were at least 80 years old (61.5%), female (98.9%), Medicare beneficiaries (73.8%), of the highest income quartile (28.6%), living in the South (34.3%), presented to non-trauma hospitals (51.5%), and presented to metropolitan non-teaching hospitals (46.0%). Factors associated with the highest risk of septicemia in breast cancer patients are the following: Medicaid patients (odds ratio (OR): 2.0, 95% Confidence Interval (CI): 1.6-2.6, p < 0.001), Medicare patients (OR: 2.0, 95% CI: 1.6-2.5, p < 0.001), private insurance patients (OR: 1.7, 95% CI: 1.4-2.1, p < 0.001), living in the West (OR: 1.5, 95% CI: 1.3-1.7, p < 0.001), living in the Northeast (OR: 1.3, 95% CI: 1.1-1.5, p < 0.001), presenting to a metropolitan non-teaching hospital (OR: 1.2, 95% CI: 1.1-1.4, p = 0.03), and presenting to a metropolitan teaching hospital (OR: 1.3, 95% CI: 1.1-1.5, p = 0.003). Almost all breast cancer patients with septicemia were admitted (97.6%), discharged the same day (1.0%), or transferred to a short-term hospital (0.7%). Amongst patients that were admitted, most patients were discharged (34.4%), transferred to a skilled nursing facility or intermediate care facility (29.8%), or died (16.2%). Risk factors associated with increased risk of dying in septicemia patients are the following: living in the Northeast (OR: 1.4, 95% CI: 1.2-1.8, p = 0.001), presenting to a metropolitan teaching hospital (OR: 1.3, 95% CI: 1.0-1.7, p = 0.046), and living in the South (OR: 1.2, 95% CI: 1.0-1.5, p = 0.045). Conclusions: After correcting for patient and hospital characteristics, a patient’s insurance status, the hospital’s region, and the hospital’s teaching status are intimately related to a breast cancer patient's risk to develop septicemia. Furthermore, hospital region and teaching status are also associated with a breast cancer patient’s risk of dying from septicemia. This suggests that a patient’s access to resources is critical for their risk of developing cancer-related complications.