title: Infectious complications in head and neck cancer patients treated with cetuximab: propensity score and instrumental variable analysis.
abstract: BACKGROUND
  To compare the infection rates between cetuximab-treated patients with head and neck cancers (HNC) and untreated patients.
  
  
  METHODS
  A national cohort of 1083 HNC patients identified in 2010 from the Taiwan National Health Insurance Research Database was established. After patients were followed for one year, propensity score analysis and instrumental variable analysis were performed to assess the association between cetuximab therapy and the infection rates.
  
  
  RESULTS
  HNC patients receiving cetuximab (n = 158) were older, had lower SES, and resided more frequently in rural areas as compared to those without cetuximab therapy. 125 patients, 32 (20.3%) in the group using cetuximab and 93 (10.1%) in the group not using it presented infections. The propensity score analysis revealed a 2.3-fold (adjusted odds ratio [OR] = 2.27; 95% CI, 1.46-3.54; P = 0.001) increased risk for infection in HNC patients treated with cetuximab. However, using IVA, the average treatment effect of cetuximab was not statistically associated with increased risk of infection (OR, 0.87; 95% CI, 0.61-1.14).
  
  
  CONCLUSIONS
  Cetuximab therapy was not statistically associated with infection rate in HNC patients. However, older HNC patients using cetuximab may incur up to 33% infection rate during one year. Particular attention should be given to older HNC patients treated with cetuximab.
authors.affiliation: Department of Otolaryngology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
authors.forename: Hsu-Chueh
authors.initials: HC
authors.lastname: Ho
authors.forename: Shih-Hsuan
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Tza-Ta
authors.initials: TT
authors.lastname: Huang
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Szu-Chin
authors.initials: SC
authors.lastname: Li
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068818:Cetuximab; D015331:Cohort Studies; D003141:Communicable Diseases / Q000150:complications* / Q000453:epidemiology; D015897:Comorbidity; D016208:Databases, Factual; D066246:ErbB Receptors / Q000378:metabolism; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D012306:Risk; D012923:Social Class; D013624:Taiwan
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D066246:ErbB Receptors; D000068818:Cetuximab