Elsevier

Clinical Oncology

Volume 30, Issue 12, December 2018, Pages e81-e82
Clinical Oncology

Letter
Risk of Death from Pneumocystis jirovecii after Curative-intent Radiotherapy for Lung Cancer

https://doi.org/10.1016/j.clon.2018.08.006Get rights and content

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    An analysis of the utilisation of chemoprophylaxis against Pneumocystis jirovecii pneumonia in patients with malignancy receiving corticosteroid therapy at a cancer hospital

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    Eighty-nine per cent of centres were willing to share learning from quality improvement projects. Some centres described a lack of awareness of the morbidity from PJP [16,17]. A recently published quality improvement project [18] described a reduction in mortality following prophylaxis for PJP.

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    However, patients receiving treatment for lung cancer with radical radiotherapy may be at higher risk because of exposure to multiple risk factors for PJP (such as lymphopenia and corticosteroid use). We previously determined the risk of death from PJP in this population to be 2.6% at 2 years (95% confidence interval 1.2–4.0%) [16]. All patients had received corticosteroids within the preceding 3 months, and 13 of 14 had lymphopenia for at least a month prior to infection.

  • Radiotherapy-Related Lymphopenia Affects Overall Survival in Patients With Lung Cancer

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    Hematologic toxicity, including lymphopenia, resulting from therapy-induced suppression of blood cells and bone marrow is known to affect the outcome of patients with cancer.15,26,27 Lymphopenia has been reported to have a negative impact on survival possibly owing to the impact on the immune system leading to reduced treatment efficacy, early tumor progression, and development of infections, especially opportunistic infections, such as Pneumocystis jirovecii pneumonia, which often lead to death.28–30 However, such opportunistic infections are difficult to diagnose in patients with lung cancer treated with radiotherapy due to a number of alternative differential diagnoses (such as radiation pneumonitis or exacerbation of comorbidities).

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