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Life sciences · Journal article
Scientific Reports · September 10, 2026
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The bidirectional relationship between cancer and infection is well established, with individuals diagnosed with cancer facing an elevated risk of severe infections, especially given the increasing prevalence of antimicrobial resistance. As cancer survival rates improve, optimizing infection management has become critical to reducing the mortality burden of infections and supporting overall outcomes in this population. This study utilized data from the Surveillance, Epidemiology, and End Results (SEER) database, encompassing 17 registries and approximately 34.6% of the U.S. population. Infection-related mortality was assessed among cancer patients diagnosed between 2000 and 2021, including deaths due to tuberculosis, syphilis, septicemia, pneumonia and influenza, and other infectious and parasitic diseases, including HIV. Causes of death were analyzed according to demographic, clinical, treatment-related, and cancer-specific characteristics. Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated across survival intervals. Between 2000 and 2021, 6,891,191 patients in the United States were diagnosed with malignant disease, of whom 82,415 died from infectious illnesses, representing approximately 1.2% of the cohort. The overall standardized mortality ratio (SMR) was 1.59, with the highest SMR estimate of 4.07 occurring within the first year after diagnosis. The greatest SMR elevations estimates were observed among patients diagnosed in more recent years (2011–2021), males, and individuals from racial or ethnic minority groups, whereas married patients exhibited lower SMR estimates. Patients with advanced-stage disease and those receiving chemotherapy experienced a higher SMR estimate, while those who underwent surgery or radiotherapy had lower SMR estimates. Pneumonia and influenza accounted for the largest proportion of deaths; however, other infectious and parasitic diseases, including HIV, were associated with the highest relative excess mortality. Notably, the greatest increased SMR estimates were observed in Kaposi sarcoma, hepatobiliary cancers, and hematologic malignancies. The present findings reveal patterns of relative excess infection-related mortality, which may guide future research and inform public health strategies aimed at reducing infection-related mortality among cancer survivors. Additional research incorporating detailed patient-level factors, such as comorbidities, treatment modalities, and socioeconomic determinants, is necessary to clarify these associations and improve outcomes in this population.