A prospective study of chemotherapy-induced febrile neutropenia in the South West London Cancer Network. Interpretation of study results in light of NCAG/NCEPOD findings

Okera, Meena; Chan, Su Yin; Dernede, U.; Larkin, James; Popat, Sanjay; Gilbert, Duncan C.; Jones, L.; Osuji, Nnenna; Sykes, H.; Oakley, Clare; Pickering, L.; Fj, Lofts; Chowdhury, Simon

doi:10.1038/sj.bjc.6606059

Cited by 19 publications

(21 citation statements)

References 30 publications

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“…Recruitment rates were initially based on the typical number of patients admitted to a specialist cancer centre with neutropenic sepsis which NICE estimates at over 20 per month (NICE, 2012). This was consistent with previously reported incidence data of 137 per million of population per year (Okera et al, 2011) and also historical audit data collected in the Belfast, Leicester and Newcastle sites. Up to date audit data shows a downward trend in neutropenic sepsis reflecting changing practice in oncology with approximately 5 admissions per site per month.…”

Section: Justification For Using a 15% Non-inferiority Marginsupporting

confidence: 93%

“…This is in line with published audit data suggesting an annual incidence of 137 episodes per million population per year based on admissions to seven hospitals in a large cancer network with a population of approximately 1.4 million. In this dataset, there were 71 hospital admissions with NS in 64 patients in a four month period with a median duration of admission of 5 days (Okera et al, 2011). De-intensification of treatment based on risk stratification is an attractive prospect in terms of reducing length of admission and healthcare utilisation costs.…”

Section: Reducing the Burden Of Ns On Patients And The Nhsmentioning

confidence: 99%

“…Up to date audit data shows a downward trend in neutropenic sepsis reflecting changing practice in oncology with approximately 5 admissions per site per month. Allowing for exclusion of high risk patients (one third of admissions (Okera et al, 2011)) and the exclusion criteria we have specified (up to a further 25%), this gives approximately 2 eligible patients admitted to each site per month.…”

Section: Justification For Using a 15% Non-inferiority Marginmentioning

confidence: 99%

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Early switch to oral antibiotics in patients with low risk neutropenic sepsis

Coyle¹,

Goodfellow²,

McMullan³

2015

http://isrctn.com/

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Protocol Title Early switch to oral antibiotic therapy in patients with low risk neutropenic sepsis. Protocol Acronym (if applicable) The EASI-SWITCH trial Protocol Number 15040RM-SS Protocol Version Number/Date V8.0_Final _21/06/2018 Protocol Amendments v1.0-v2.0-v1.0 was never approved for use. v20 incorporated changes to section 8.3 regarding IMP as requested by MHRA. V2.0-3.0 Incorporated changes to eligibility criteria V3.0-4.0 incorporated changes to Pilot phase timeline V4.0-5.0 incorporated further changes to eligibility criteria V4.0-v5.0 key changes;

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Section: Justification For Using a 15% Non-inferiority Marginsupporting

confidence: 93%

Section: Reducing the Burden Of Ns On Patients And The Nhsmentioning

confidence: 99%

Section: Justification For Using a 15% Non-inferiority Marginmentioning

confidence: 99%

See 1 more Smart Citation

Early switch to oral antibiotics in patients with low risk neutropenic sepsis

Coyle¹,

Goodfellow²,

McMullan³

2015

http://isrctn.com/

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show abstract

“…In contrast, both crude and adjusted estimates were statistically significant and in the direction of an increased risk for CIN. No between-group differences, as judged by non-overlapping confidence intervals, were observed between any of the groups (Okera et al, 2011). …”

Section: Resultsmentioning

confidence: 99%

The association of hyperglycemia and diabetes mellitus and the risk of chemotherapy-induced neutropenia among cancer patients: A systematic review with meta-analysis

Alenzi

Kelley

2017

Journal of Diabetes and its Complications

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Aim Conduct a systematic review with meta-analysis to determine the association between incident chemotherapy-induced neutropenia (CIN) and either diabetes mellitus (DM) or hyperglycemia in patients with cancer. Methods Observational studies in cancer patients of any age receiving chemotherapy and having diabetes or hyperglycemia either during or before chemotherapy induction were included. Studies were retrieved by searching four databases (PubMed, EBSCO, ProQuest, and Cochrane) and cross-referencing. The metric for combining studies was the odds ratio (OR). Results were pooled using a random-effects model, while heterogeneity and inconsistency were assessed using the Q and I2 statistic, respectively. Potential small-study effects were assessed using the funnel plot. Results Ten studies met the criteria for inclusion. Overall, the odds of having CIN were 32% higher among cancer patients with either DM or hyperglycemia compared with those without DM or hyperglycemia (OR = 1.32, 95% CI, 1.06–1.64). Statistically significant heterogeneity and inconsistency were found (Q = 33.15, p < 0.05, I2 = 72.9%). Funnel plot asymmetry reflecting potential small-study effects was observed. Conclusions Diabetes mellitus and hyperglycemia may be associated with an increased risk for CIN among cancer patients. However, additional well-designed studies are needed before any final and definitive recommendations can be made.

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“…We assumed that an episode of febrile neutropenia would be managed with a 5-day hospitalization [15]. We assumed that grade 3/4 anemia would be managed with one outpatient visit and transfusion of two units of red blood cells (RBC).…”

Section: Adverse Event (Ae) Costsmentioning

confidence: 99%

Cost description of chemotherapy regimens for the treatment of metastatic pancreas cancer

et al. 2016

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Multiple chemotherapy regimens are available for the treatment of metastatic pancreas cancer (mPCA). Choice of regimen is based on the patient's performance status and toxicity profile of the regimen. The objective of this study was to analyze the costs of first-line regimens to further aid in decision-making and develop a platform upon which to assess value. We calculated the monthly cost for individual standard regimens (gemcitabine, gemcitabine/nab-paclitaxel, gemcitabine/erlotinib and FOLFIRINOX) and the overall treatment cost for a course of therapy based on the median progression-free survival achieved in published studies. In addition to cost of drugs, we included administration costs and costs of toxicities (including growth factor support, blood product transfusion and hospitalization for toxicities). Costs for administration and management of adverse events were based on Medicare reimbursement rates for hospital and physician services. Drug costs were based on Medicare average sale prices (all 2014 US$). The monthly costs for gemcitabine, FOLFIRINOX, gemcitabine/erlotinib and gemcitabine/nab-paclitaxel were $1363, $7234, $8007 and $12,221, respectively. The overall treatment costs for a course of the same regimens based on median PFS were $5043, $46,298, $51,004 and $67,216, respectively. The choice of chemotherapy regimen for mPCA should be based on tolerability and efficacy of the regimen individualized to patient's performance status. Healthcare systems have finite resources; thus, there is increasing emphasis on metrics to define value in health care when outcomes of therapy are similar or produce marked differences in value. These data provide useful financial information to incorporate into the decision-making process.

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A prospective study of chemotherapy-induced febrile neutropenia in the South West London Cancer Network. Interpretation of study results in light of NCAG/NCEPOD findings

Cited by 19 publications

References 30 publications

Early switch to oral antibiotics in patients with low risk neutropenic sepsis

Early switch to oral antibiotics in patients with low risk neutropenic sepsis

The association of hyperglycemia and diabetes mellitus and the risk of chemotherapy-induced neutropenia among cancer patients: A systematic review with meta-analysis

Cost description of chemotherapy regimens for the treatment of metastatic pancreas cancer

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