title: The association between infections and chemotherapy interruptions among cancer patients: prospective cohort study.
abstract: OBJECTIVE
  Adherence to scheduled chemotherapy is important for optimal outcomes of cancer patients. We examined causes for delay or cancellation of planned chemotherapy, focusing on mild respiratory infections during the winter.
  
  
  METHODS
  Prospective cohort study. We included all adults with solid or hematologic cancer receiving active chemotherapy treatment during the winter of 2010-2011 in a cancer center. We compared baseline characteristics and outcomes between patients with and without chemotherapy delays, cancellations, or dose-reductions ("chemotherapy delay").
  
  
  RESULTS
  We included 547 patients receiving chemotherapy during the winter of 2011. Of these, 213 (38.9%) patients experienced 306 episodes of chemotherapy delays. The main documented reasons for the chemotherapy delay were neutropenia (84/306, 27.4%), fever or infection (73/306, 23.9%) and thrombocytopenia (26/306, 8.5%). Independent risk factors for chemotherapy delays were upper respiratory infections (OR 1.87, 95% CI 1.27-2.76), lymphopenia, prior hospitalization, peripheral vascular disease and colon cancer relative to hematologic cancer. In the adjusted analysis focusing on chemotherapy delays due to infection alone, upper respiratory infections (OR 5.25, 95% I 2.81-9.84) and age were significant independent risk factors.
  
  
  CONCLUSIONS
  Mild respiratory infections were associated with chemotherapy delays. Our results should encourage modalities to prevent influenza and other upper respiratory infections among cancer patients.
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Taha
authors.affiliation: Pharmacy Services, Schneider Children's Medical Center, Petah Tikva, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Vinograd
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ali
authors.initials: A
authors.lastname: Sakhnini
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Eliakim-Raz
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Laura
authors.initials: L
authors.lastname: Farbman
authors.affiliation: Department of Oncology - Hematology, Schneider Children's Medical Center, Petah Tikva, Israel.
authors.forename: Rina
authors.initials: R
authors.lastname: Baslo
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute of Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Salomon M
authors.initials: SM
authors.lastname: Stemmer
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. Electronic address: paulm@post.tau.ac.il.
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005334:Fever; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007251:Influenza, Human / Q000150:complications; D008231:Lymphopenia; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy*; D009503:Neutropenia; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000821:virology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013921:Thrombocytopenia
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Influenza; Malignancy; Medication adherence; Neutropenia; Respiratory tract infections