Sepsis as a cause of death among elderly cancer patients: an updated SEER database analysis 2000-2021

Sepsis is an aggressive response to an infection leading to widespread inflammation, and may lead to death. It remains a significant challenge for cancer patients especially for the elderly due to their immunocompromised status and other comorbidities. So, this study aimed to assess the risk of mortality due to sepsis among elderly cancer patients and provide an updated evidence to the literature for better management outcomes.

We used data from the Surveillance, Epidemiology, and End Results (SEER) program. We included cancer patients who died due to sepsis between 2000 and 2021. The Standardized Mortality Ratio (SMR) for elderly cancer patients who died due to sepsis was calculated as observed/expected (O/E). We used 95% confidence intervals (CI) and the excess risk (ER) was per 100 000. Significance was achieved at 0.05.

Out of 5 239 194 elderly cancer patients, 18 311 died from sepsis. Men represented 55% and the majority were Caucasians (82%). Death from sepsis along 10+ years of follow-up had a significant SMR with an O/E of 1.32 (P >0.05, 95% CI: 1.30-1.34, ER = 2.56) especially within the first year after cancer diagnosis (O/E = 3.00, P >0.05). Gastric cancer had an increased risk for sepsis death in the elderly (O/E = 2.55, P < 0.05, 95% CI: 2.28-2.85). Liver and intrahepatic bile cancer had a significant SMR for sepsis (O/E = 5.56, P < 0.05, 95% CI: 5.01-6.36). However, it had an insignificant risk for sepsis deaths along 120+ months of follow-up period (O/E = 1.21, 95% CI: 0.25-3.52, ER = 1.73).

Sepsis is a rapid silent killer targeting a vulnerable population. Although it had a declining mortality rate along 10+ years of follow up as the majority die due to other cancer-related and non-cancer-related causes, it still represents a certain threat to elderly cancer patients due to the immunosuppression of cancer treatment regimen and antibiotic resistance. Further studies are encouraged to focus on elderly cancer patients' health care and to intensify infection control measures.