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  • br Funding Funding for this work


    Funding Funding for this work was provided by the National Institutes of Health, National Cancer Institute, NCI Community Oncology Research Program (NCORP) Research Base grant 5UG1CA189974, National Cancer Institute grant UM1CA182883, and by the Dr Charles A. Coltman, Jr, Fellowship Program of the Hope Foundation.
    Role of the funder/sponsor
    Author contributions
    Conflict of interest statement
    Introduction Sepsis, characterized by a systemic inflammatory response to an infection, is a major public health problem responsible for more than 200,000 deaths and 750,000 hospitalizations annually in the United States (US) [[1], [2], [3]]. Among hospitalized patients, cancer patients are nearly ten times more likely to develop sepsis when compared with no cancer history patients [4]. A diagnosis of sepsis among cancer patients has been shown to increase the risk of mortality up to 2 to 3- fold, making sepsis a significant but modifiable threat to cancer survivorship [[4], [5], [6], [7]]. Treatment modalities for cancer have improved in the past decades, with average 5-year survival approaching 70% [8,9]; however, there are disparities in survival rates by race and socio-economic status, a trend that mirrors disparities in sepsis rates among US adults [4,[10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27]]. Cancer and sepsis have a physiologically plausible association, as infections are common complications among cancer patients receiving major cancer surgeries or treatment within the hospital setting [6]. However, there exists limited epidemiologic evidence to support the mechanism of cancer survivors having long-term increased risk of sepsis years following their perspective cancers. Further, there is very limited evidence for the association between cancer and sepsis among a longitudinal cohort of participants considered Benazepril dwelling at baseline. Little attention has focused on risk of infection among cancer survivors living in communities as past research has focused exclusively among hospitalized cancer patients receiving surgical treatment and/or emergency care. An important and inherent limitation of prior studies was the use of hospital discharge data to identify sepsis events and the assessment of hospital-acquired rather than community acquired sepsis [[4], [5], [6]]. First, in hospital discharge datasets, it is difficult disentangle early (community-acquired) sepsis from later (hospital-acquired) sepsis as a result of limited availability of present-on-admission status of the sepsis diagnosis [28]. Secondly, there is often insufficient information about confounders on the association of cancer and sepsis including initial clinical presentation; chronic comorbidities such as diabetes and obesity; personal characteristics such as income, education, and body mass index; and behavioral characteristics such as smoking, alcohol use, and diet. Modern cancer treatment and therapies have improved cancer survivorship over the past few decades, but there are inherent properties of cancer and effects of treatment that may cause cancer survivors to have reduced immune function and affect overall quality of life when compared with the general population. To date, there is limited knowledge on the risk of sepsis among cancer survivors as compared with participants with no cancer within a well-defined longitudinal cohort of community-dwelling adults [[4], [5], [6]]. Therefore, the objective of this study was to determine the risk of sepsis after cancer compared with no cancer history participants in the REGARDS cohort. Additionally, because there is conflicting evidence on racial differences in sepsis we aimed to determine whether risk of sepsis after cancer was modified by race [[4], [5], [6],[24], [25], [26],[29], [30], [31], [32], [33]]. We hypothesize that, within the REGARDS cohort, sepsis risk will be higher among cancer survivors when compared to those without a history of cancer and that there will be racial differences in the risk of sepsis after cancer.