Pre-existing cancer as a risk factor for poor outcomes after burn injury.

Abstract

e24033 Background: With a growing population of cancer survivors, assessing health outcomes and improving patient care is increasingly important. Severe burns compromise health by disrupting the immune response. This study seeks to determine how severe burn injuries affect outcomes in individuals with pre-existing cancer diagnoses. Methods: Using the TriNetX research network, 46,275 patients with a neoplasm diagnosis prior to a burn injury were identified. Two control groups were established: cancer patients without burns and burn patients without cancer. The test group included patients with a pre-existing cancer diagnosis who sustained a subsequent burn injury. Outcomes analyzed included mortality (tracked at 1, 3, 5, and 10 years post-injury), sepsis, nutritional deficiency, eating disorder, immunodeficiency, and depression. Logistic regression analysis was conducted to assess patient mortality, and odds ratios with 95% confidence intervals were calculated for all outcomes. Results: Of nearly 10 million cancer patients, 0.45% experienced a burn injury after diagnosis. Compared to propensity-matched burn patients without cancer, those with a prior cancer diagnosis had significantly higher odds of developing sepsis (OR 2.01, 95% CI 1.90-2.14), nutritional deficiency (OR 1.87, 95% CI 1.58-2.22), immunodeficiency (OR 5.58, 95% CI 4.85-7.06), eating disorders (OR 2.38, 95% CI 1.95-2.92), and depression (OR 1.77, 95% CI 1.70-1.85). Compared to cancer patients without burns, they also had elevated risks of sepsis (OR 1.72, 95% CI 1.61-1.83), nutritional deficiency (OR 1.96, 95% CI 1.59-2.42), immunodeficiency (OR 1.27, 95% CI 1.10-1.46), eating disorders (OR 2.57, 95% CI 2.08-3.18), and depression (OR 1.54, 95% CI 1.47-1.61). Patients with hematologic cancers fared worse across all outcomes compared to those with solid tumors, and those who received chemotherapy or radiation faced worse outcomes than those who did not. The 10-year mortality rate for cancer patients with subsequent burn injuries was 6.6%, compared to 2.1% for burn patients without a history of cancer. Conclusions: Patients with pre-existing neoplasms who sustain a burn injury are at increased risk for developing complications. When treating burn patients with a history of cancer, providers should prioritize early tube feeding, appropriate vitamin supplementation, counseling or psychiatric follow-up, and timely, targeted antibiotic therapy to improve outcomes. Patient demographics. Cancer + Burns (n=46,275) Burns (n=340,905) Cancer (n=9,676,267) Age Mean ± SD 60 ± 19 36 ± 22 61 ± 19.5 Gender Female 28663 (62%) 148189 (43%) 5546104 (57%) Male 17598 (38%) 192599 (56%) 4126806 (43%) Race White 32943 (71%) 201208 (59%) 6642574 (69%) Black 7529 (16%) 63659 (19%) 1100860 (11%) Asian 737 (2%) 7048 (2%) 179945 (2%) American Indian 164 1486 28141 Pacific Islander 36 869 8259 Unknown Race 4866 66635 1716488