Chemotherapy-Induced Neutropenia and Febrile Neutropenia in the US: A Beast of Burden That Needs to Be Tamed?

Abstract

Neutropenia and febrile neutropenia (FN) are common complications of myelosuppressive chemotherapy. This review provides an up-to-date assessment of the patient and cost burden of chemotherapy-induced neutropenia/FN in the US, and summarizes recommendations for FN prophylaxis, including the interim guidance that was recommended during the coronavirus disease 2019 (COVID-19) pandemic. This review indicates that neutropenia/FN place a significant burden on patients in terms of hospitalizations and mortality. Most patients with neutropenia/FN presenting to the emergency department will be hospitalized, with an average length of stay of 6, 8, and 10 days for elderly, pediatric, and adult patients, respectively. Reported in-hospital mortality rates for neutropenia/FN range from 0.4% to 3.0% for pediatric patients with cancer, 2.6% to 7.0% for adults with solid tumors, and 7.4% for adults with hematologic malignancies. Neutropenia/FN also place a significant cost burden on US healthcare systems, with average costs per neutropenia/FN hospitalization estimated to be up to $40 000 for adult patients and $65 000 for pediatric patients. Evidence-based guidelines recommend prophylactic granulocyte colony-stimulating factors (G-CSFs), which have been shown to reduce FN incidence while improving chemotherapy dose delivery. Availability of biosimilars may improve costs of care. Efforts to decrease hospitalizations by optimizing outpatient care could reduce the burden of neutropenia/FN; this was particularly pertinent during the COVID-19 pandemic since avoidance of hospitalization was needed to reduce exposure to the virus, and resulted in the adaptation of recommendations to prevent FN, which expanded the indications for G-CSF and/or lowered the threshold of use to >10% risk of FN.

Neutropenic Fever–Associated Admissions Among Patients With Solid Tumors Receiving Chemotherapy During the COVID-19 Pandemic

“…Neutropenic fever (NF) occurs in up to 30% of patients with cancer receiving chemotherapy, affecting more than 60 000 patients annually in the US . Only 50% of NF cases have identified causes, but all patients with NF receive empirical antibiotics .…”

“…Neutropenic fever (NF) occurs in up to 30% of patients with cancer receiving chemotherapy, affecting more than 60 000 patients annually in the US . Only 50% of NF cases have identified causes, but all patients with NF receive empirical antibiotics . During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) were instituted to limit the transmission of COVID-19 .…”

“… 2 Only 50% of NF cases have identified causes, but all patients with NF receive empirical antibiotics. 1 , 2 During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) were instituted to limit the transmission of COVID-19. 3 These NPIs also were associated with decreased rates of common seasonal respiratory viruses.…”

Nurse-led study on treatment delay and streamlining antibiotic therapy among haematology patients with febrile neutropenia post chemotherapy

“…This demographic profile is consistent with the demographics in other FN studies. [11][12][13] The top three haematological malignancies the patients had were Acute Myeloid Leukemia (AML), Multiple Myeloma (MM) and Mantle Cell Lymphoma, with 61% of the patients being inpatients. Patient demographics are detailed in Table 1.…”

A Pilot Study Indicates an Essential Link between a Mild Deterioration in Excretory Kidney Function and the Risk of Neutropenia during Cancer Chemotherapy

“…Furthermore, FN-related hospitalizations generate high costs to health systems [6]. The above facts resulted in the publishing by the European Society for Medical Oncology [7] and the American Society of Clinical Oncology [8] guidelines for FN prophylaxis.…”