According to a recent study conducted by Memorial Sloan Kettering Cancer Center, rates of Clostridioides difficile infection (CDI) are higher in patients with cancer than in healthy adults. This study used patient data from 93,566 patients in the SEER-Medicare database, including both healthy patients and patients with either solid tumors or hematologic malignancies diagnosed between 2006 and 2010. Among all patients evaluated in this study, CDI occurred in 2.6%, with a greater proportion of patients with cancer impacted compared with healthy patients (2.8% vs 2.4%). CDI occurred more commonly in female patients and patients living in the Northeast and metropolitan areas. Risk increased with age, from 1.9% among patients aged 66 to 69, to 2.9% for patients older than 85 years. Highest risk was seen in patients with hematologic malignancies. Among patients with solid tumors, the increased rates of CDI were only observed in patients with a recent cancer diagnosis and those who had distant metastases at diagnosis.
High Altitude: This study is of great interest to researchers involved in the development of novel cancer therapies. Increased rates of CDI among older patients with cancer may result in a perception of diarrhea and colitis as treatment-related adverse events (AEs). It is important moving forward for patients treated on clinical trial who develop symptoms of diarrhea to be tested for CDI, and for prophylactic strategies to be used among at-risk populations, such as elderly patients with hematologic malignancies.
Ground Level: Diarrhea and colitis are increasingly common AEs associated with cancer treatment. However, this article is a good reminder that not all cases of diarrhea are associated with cancer therapy. It is important for community oncologists to be aware of the increased risk of CDI among their patients with cancer and to check for infectious causes in patients presenting with diarrhea during cancer treatment, particularly in elderly patients.