Influenza activity and regional mortality for non-small cell lung cancer

Background: 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 cancer patients remains largely unknown. Methods: : 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. Results: : 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1,049 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. Conclusion: Increased influenza activity is associated with higher mortality rates for NSCLC patients. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related cancer deaths in the U.S.