History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF prophylaxis

Chao, Chun; Page, John H.; Yang, Su‐Jau; Rodríguez, Roberto; Huynh, Justin P; Chia, Victoria

doi:10.1093/annonc/mdu203

Cited by 65 publications

(65 citation statements)

References 21 publications

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“…In addition to those mentioned above, the retrospective use of EMR data is subject to potential misclassification of the FN outcome and predictors due to inadequate or undercoding, which may negatively affect the evaluation of model performance. We developed and evaluated the new prediction models in the same study population that was previously used to identify these comorbidities as FN risk factors;9, 10, 11, 12 however, we split the study population into training and validation datasets and applied the beta coefficients obtained in the training set to the validation set to mitigate potential issues with overfitting. Patients who were excluded from the study because they received G‐CSF or antibiotics might have been those at highest risk of FN or those with comorbidities, and this may have left lower‐risk patients in the study cohort and biased our results.…”

Section: Discussionmentioning

confidence: 99%

“…Only the first cycle was assessed to obtain the most unbiased FN risk, because FN risk in subsequent cycles might be affected by dose modification due to other complications. FN was defined by a combination of ICD‐9 codes, laboratory values, and health service utilization, using one of the following methods:10, 11, 12, 14 (1) neutropenia ICD‐9 code 288.0 and fever ICD‐9 code 780.6 (within 7 days); or (2) absolute neutrophil count (ANC) <1000/μL and fever ICD‐9 code 780.6 (within 7 days); or (3) hospitalization with neutropenia ICD‐9 code 288.0 as the primary diagnosis; or (4) neutropenia ICD‐9 code 288.0 or ANC <1000/μL within 7 days of hospitalization with ICD‐9 code of bacterial/fungal infection.…”

Section: Methodsmentioning

confidence: 99%

“…A 2‐way interaction term between obesity and diabetes was included in the new model, as a previous study12 had shown that diabetes was associated with increased FN risk only among patients who were not overweight/obese.…”

Section: Methodsmentioning

confidence: 99%

“…The possible biologic mechanisms underlying these risk factors include bone marrow suppression, impaired neutrophil function, compromised skin/mucosal barrier integrity, and disturbances of the microbiome 12. Based on these hypothesized underlying pathological mechanisms, it is possible that these comorbidities may provide additional value in FN risk prediction.…”

Section: Introductionmentioning

confidence: 99%

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Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia

Family

Chen

et al. 2018

Cancer Medicine

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Several comorbidities have recently been shown to affect risk of chemotherapy‐induced febrile neutropenia (FN). Here, we evaluated the added predictive value of these comorbidities beyond established FN risk factors. A retrospective cohort study was conducted among adult patients diagnosed with cancer and treated with chemotherapy at Kaiser Permanente Southern California between 2000 and 2009. The study cohort was equally split into training and validation datasets to develop and evaluate the performance of FN risk prediction models in the first chemotherapy cycle. A reference model was developed based on the model proposed by Lyman et al (Cancer 2011;117:1917). A new model was developed by incorporating the newly identified comorbidities such as rheumatoid conditions and thyroid disorders into the reference model. Area under the receiver operating characteristic curve (AUROCC), risk reclassification, and integrated discrimination improvement (IDI) were used to evaluate the potential improvement of FN risk prediction by incorporating comorbidities. A total of 15 279 patients were included; 4.2% experienced FN in the first chemotherapy cycle. Including comorbidities in FN risk prediction did not improve AUROCC (reference model 0.71 vs new model 0.72). A significant improvement in individual‐level FN risk prediction was indicated by IDI (P = .02). However, significant improvement in risk reclassification was not observed overall (although 6% of all patients were more accurately classified for their FN risk level, 5% were less accurately classified) or when examining predicted FN risk among patients who did and did not develop FN. Incorporating several new comorbidities into FN prediction led to improved FN risk prediction in the first chemotherapy cycle, although the observed improvements were small and might not be clinically relevant.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia

Family

Chen

et al. 2018

Cancer Medicine

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“…6,9 Another piece of data supporting our findings is the inverse association between obesity and risk of febrile neutropenia that has been reported recently. 10 Potential mechanisms include altered pharmacokinetics and/or reduced relative efficacy of chemotherapy due to obesity. To the Editor-We read with interest the recent article "CLABSI or Munchausen's or Both" 1 because, among other aspects, it addressed the interactions between patient psychosocial status and general medical quality and safety measures.…”

mentioning

confidence: 99%

Patients with Psychiatric Disorders Can Also Have CLABSIs: A Response to “CLABSI or Munchausen’s or Both”

Brooks

Christy

Mack

et al. 2015

Infect. Control Hosp. Epidemiol.

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(range) BMI was 28.0 (15-46). Taking all 335 CVCs together, the BMI of the patients was a mean of 27.3, whereas in 95 CVCs (28.4%), the BMI of the patients was at least 30 (for the subgroup of the obese patients the mean BMI was 33.8).Complications of CVC insertion (bleeding, hematoma, >2 punctures, or malpositioning of the guidewire) were reported in 18.3% of obese patients and in 18.4% of non-obese patients. This indicates no increased risk for complications during CVC insertion among obese patients (odds ratio [OR], 0.99].Comparing the CRBSI rate in obese and in non-obese patients we found no differences in CRBSI frequency (22.1% vs 23.3%; OR, 0.93).Duration of CVC use appeared to be significantly shorter in obese compared with non-obese patients (13.5 vs 15.9 days). However, using the modified Infection Probability Score, 6

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The effect of comorbidity on the use of adjuvant chemotherapy and type of regimen for curatively resected stage III colon cancer patients

Hsieh

Thompson

et al. 2016

Cancer Medicine

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Postsurgical chemotherapy is guideline‐recommended therapy for stage III colon cancer patients. Factors associated with patients not receiving adjuvant chemotherapy were identified in numerous studies; comorbidity was recognized as an important factor besides patient's age. We assessed the association between comorbidity and the use of adjuvant chemotherapy and type of chemotherapy regimen. Stage III colon cancer patients who underwent surgical resection were obtained from ten Centers for Disease Control and Prevention (CDC)‐NPCR Specialized Registries which participated in the Comparative Effectiveness Research (CER) project. Comorbidity was classified into no comorbidity recorded, Charlson, non‐Charlson comorbidities, number, and severity of Charlson comorbidity. Pearson chi‐square test and multivariable logistic regression were employed. Of 3180 resected stage III colon cancer patients, 64% received adjuvant chemotherapy. After adjusting for patient's demographic and tumor characteristics, there were no significant differences in receipt of chemotherapy between Charlson and non‐Charlson comorbidity. However, patients who had two or more Charlson comorbidities or had moderate to severe disease were significantly less likely to have chemotherapy (ORs 0.69 [95% CI, 0.51–0.92] and 0.62 [95% CI, 0.42–0.91], respectively) when compared with those with non‐Charlson comorbidity. In addition, those with moderate or severe comorbidities were more likely to receive single chemotherapy agent (P < 0.0001). Capecitabine and FOLFOX were the most common single‐ and multi‐agent regimens regardless of type of comorbidity grouping. Both the number and severity of comorbidity were significantly associated with receipt of guideline‐recommended chemotherapy and type of agent in stage III resected colon cancer patients. Better personalized care based on individual patient's condition ought to be recognized.

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History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF prophylaxis

Abstract: These results provide evidence that history of several chronic comorbidities increases risk of FN, which should be considered when managing patients during chemotherapy.

Cited by 65 publications

References 21 publications

Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia

Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia

Patients with Psychiatric Disorders Can Also Have CLABSIs: A Response to “CLABSI or Munchausen’s or Both”

The effect of comorbidity on the use of adjuvant chemotherapy and type of regimen for curatively resected stage III colon cancer patients

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