title: Impact of infections on the survival of hospitalized advanced cancer patients.
abstract: BACKGROUND
  Advanced cancer patients remain highly susceptible to infections, leading to significant morbidity and mortality. A lack of consensus on the management of infections in this population stems from the heterogeneity of the patient group, divergent goals of care, and unknown prognosis with antibiotic treatment.
  
  
  OBJECTIVE
  This prospective single cohort study examined the impact of infection and its treatment on the survival of hospitalized advanced cancer patients compared with a similar cohort without infection.
  
  
  METHODS
  A total of 441 patients were referred to the palliative care (PC) consult service in a tertiary hospital over a 12-month period. The occurrence of sepsis, organ-related infection, and antibiotic use were recorded on initial PC consult. Survival was calculated from the point of PC consult to the date of death.
  
  
  RESULTS
  Of these patients, 16.6% suffered a recent episode of sepsis (with or without an identifiable organ-related infection) and 23.4% had a recent episode of organ-related infection without clinically evident sepsis. Among the patients with sepsis, organ-related infection, or both, 89.7% received antibiotics (intravenous, oral, or both). Median survival of septic and nonseptic patients was 15 and 42 days, respectively. Septic patients who responded poorly to treatment (nonresponders) had a median survival of five days vs. 142 days in good responders. This equates with a hazard ratio of 9.74 for death in antibiotic nonresponders (P<0.05). Median survival for patients with an untreated organ-related infection (no sepsis) was 27 days compared with 48 days in a similar cohort receiving antibiotic therapy. Among patients on IV antibiotics, nonresponders had a median survival of six days vs. 108 days in responders. For patients on oral antibiotics, nonresponders had a median survival of six days vs. 70 days in responders.
  
  
  CONCLUSIONS
  These findings suggest that a recent episode of sepsis and/or organ-related infection significantly reduces overall patient survival. Favorable antibiotic response is associated with an increase in median survival. These findings suggest that antibiotic treatment may prolong survival, and a time-limited trial may be indicated contingent on goals of care.
authors.affiliation: University of Alberta Hospital, Edmonton, Alberta. vincent.thai@albertahealthservices.ca
authors.forename: Vincent
authors.initials: V
authors.lastname: Thai
authors.forename: Francis
authors.initials: F
authors.lastname: Lau
authors.forename: Gary
authors.initials: G
authors.lastname: Wolch
authors.forename: Ju
authors.initials: J
authors.lastname: Yang
authors.forename: Hue
authors.initials: H
authors.lastname: Quan
authors.forename: Konrad
authors.initials: K
authors.lastname: Fassbender
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D010166:Palliative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications; D013534:Survival
chemical_list: D000900:Anti-Bacterial Agents