Influenza activity and regional mortality for non-small cell lung cancer
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1.
California Institute of Technology
Abstract
Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041–0.042) and 0.051 (95% CI 0.050–0.053), respectively (RR 1.24 [95% CI 1.21–1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.
Copyright and License
© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Contributions
C.J.K.: Conceptualization, study design, data acquisition, data analysis, oversight of analysis, interpretation of data, writing, editing. Y.W.: Study design, data acquisition, data analysis, oversight of analysis, interpretation of data, writing, editing. Y.L.: Data acquisition. K.M.Z.: Data analysis, oversight of analysis, interpretation of data. K.R.C.: Oversight of analysis, interpretation of data. T.J.C.W.: Oversight of analysis, interpretation of data, editing, administrative support and oversight. C.D.: Study design, oversight of analysis, interpretation of data, administrative support and oversight. M.A.: Oversight of analysis, interpretation of data, administrative support and oversight. S.K.C.: Conceptualization, study design, oversight of analysis, interpretation of data, editing, administrative support and oversight.
Data Availability
Data is available upon request to the National Cancer Institute and Center for Disease Control, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Permissions can be obtained through the SEER website (https://seer.cancer.gov/data/access.html).
Conflict of Interest
Dr. Cheng reported receiving grants from Janssen and travel funding from Caris outside the submitted work. Dr. Wang reports personal fees and non-financial support from AbbVie, personal fees from Cancer Panels, personal fees from Doximity, personal fees and non-financial support from Elekta, personal fees and non-financial support from Merck, personal fees and non-financial support from Novocure, personal fees and non-financial support from RTOG Foundation, personal fees from Wolters Kluwer, grants and non-financial support from Genentech, grants and non-financial support from Varian, personal fees from Iylon Precision Oncology, outside the submitted work. No other authors have financial conflicts of interest.
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Additional details
- PMCID
- PMC10709588