BackgroundCancer predisposes patients to Clostridium difficile infection (CDI) due to health care exposures and medications that disrupt the gut microbiota or reduce immune response. Despite this association, the national rate of CDI among cancer patients is unknown. Furthermore, it is unclear how CDI affects clinical outcomes in cancer. The objective of this study was to describe CDI incidence and health outcomes nationally among cancer patients in the United States (U.S.).MethodsData for this study were obtained from the U.S. National Hospital Discharge Surveys from 2001 to 2010. Eligible patients included those at least 18 years old with a discharge diagnosis of cancer (ICD-9-CM codes 140–165.X, 170–176.X, 179–189.X, 190–209.XX). CDI was identified using ICD-9-CM code 008.45. Data weights were applied to sampled patients to provide national estimates. CDI incidence was calculated as CDI discharges per 1000 total cancer discharges. The in-hospital mortality rate and hospital length of stay (LOS) were compared between cancer patients with and without CDI using bivariable analyses.ResultsA total of 30,244,426 cancer discharges were included for analysis. The overall incidence of CDI was 8.6 per 1000 cancer discharges. CDI incidence increased over the study period, peaking in 2008 (17.2 per 1000 cancer discharges). Compared to patients without CDI, patients with CDI had significantly higher mortality (9.4% vs. 7.5%, p < 0.0001) and longer median LOS (9 days vs. 4 days, p < 0.0001).ConclusionsCDI incidence is increasing nationally among cancer patients admitted to U.S. community hospitals. CDI was associated with significantly increased mortality and hospital LOS.

OBJECTIVES:To examine the factors associated with total health care expenditures in newly diagnosed subjects with colorectal cancer (CRC) receiving systemic therapy. METHODS: Patients ages 18-63 years when newly diagnosed with CRC between January 1, 2005 and June 31, 2009 receiving systemic therapy were identified using a large, US-based administrative medical claims (MarketScan) database. At least 6 months of patient history prior to CRC diagnosis and at least 1-year post-index continuous enrollment was required. Patients were followed from initial CRC diagnosis (index date) to disenrollment or June 31, 2010. Chemotherapy and biologic treatments over time were analyzed to identify lines of therapy. Generalized linear regression models were used to estimate total medical expenditures (outcome variable) as a function of number of lines of therapy (key independent variable) and demographic/clinical covariates. The excess expenditures associated with additional lines of therapy were estimated as the difference between predicted medical expenditures for those with 1 st line of therapy versus 2 nd and 3 rd ϩ lines of therapy. RESULTS: A total of 5160 subjects were included with the majority being male (55%) and between ages 51-60 years (52%). After adjusting for demographic, and clinical covariates (comorbidities, metastasis development, and postindex CRC surgery and radiation) and follow-up days, the mean annualized total health care costs (Nϭ5,160) were predicted to be $67,902. Use of 2 nd line and 3 rd line ϩ therapies was associated with an annualized

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