Incidence, cost, and mortality of neutropenia hospitalization associated with chemotherapy

Abstract

BACKGROUNDNeutropenia is a common side effect of chemotherapy, often requiring hospitalization for treatment of severe cases. Neutropenia hospitalization (NH) rates have been reported in individual studies, but national estimates are needed.METHODSChemotherapy‐induced NHs were identified in the 1999 hospital discharge data bases from 7 states. Cancer and chemotherapy prevalence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program and the National Cancer Data Base were used to calculate national NH rates for 13 cancer types. NH cost was estimated by multiplying charges by institution‐specific, cost‐to‐charge ratios from the 1999 Centers for Medicare and Medicaid Services Hospital Cost Report. NH incidence was projected to national levels using population data from the United States Census and the Centers for Disease Control and Prevention.RESULTSThere were 20,780 discharges with documentation of cancer, chemotherapy, and neutropenia identified. Projecting to national levels, NH incidence was estimated at 60,294 cases (7.83 cases per 1000 cancer patients). The mean NH cost was $13,372. The mortality rate among patients with NH was estimated at 6.8% or 1 death for every 14 hospitalized patients. Among 13 selected cancer types, the NH rate was 34.20 cases per 1000 patients receiving chemotherapy (1 in 29 patients). NH was particularly common in patients with hematologic tumors, with an incidence of 43.3 cases per 1000 patients with such tumors (1 in 23 patients). The average NH cost for hematologic malignancies was $20,400, more than double the cost of NH for solid tumors.CONCLUSIONSAccording to the current study, NH affects > 60,000 patients with cancer each year in the United States, with an average cost of $13,372 per hospitalization and an associated inpatient mortality rate of 6.8%. Cancer 2005. © 2005 American Cancer Society.

Management of Febrile Neutropenia in Patients receiving Chemotherapy for Solid Tumors: A Retrospective Study of Twenty Cases from the Radiotherapy Centre, Accra, Ghana

“…Most cause a blood count nadir at 10 to 14 days, but can occur anytime from a few days to about 6 weeks depending on the drug. 1 The relationship between low neutrophil count and the increased risk of infection was published in 1966 by Bodey GP et al 4 They noted that the major threat of neutropenia is bacterial infection, and the greatest risk was in patients with ANC less than 0.1 x10 9 L cells. Signs and symptoms of infection are however often subtle due to a lack of adequate inflammatory response.…”

“…1 The febrile episode is preceded by a reduction in the absolute neutrophil count (ANC) which comprises of segments, blasts and neutrophils. Even though neutropenia is defined as ANC less than 1.0 x10 9 L cells, this figure is referenced for Caucasians and there is a suggestion that it in blacks it should be less than 1.2 x 10 9 L cells due to mild neutropenia being a normal phenomenon.…”

“…2 Febrile neutropenia is defined as a single oral temperature of > 38.3 o C or 38 o C for more than one hour, associated with a significant reduction in granulocyte count (ANC < 0.5 x10 9 L or 1.0 x 10 9 L cells, but predicted to fall to <500cells/ mm 3 ). 1 Mortality rates have reduced from 50 percent in the 1960s to less than 10 percent today due to improved management strategies. 3 Most chemotherapy agents/protocols have the potential of causing febrile neutropenia.…”

“…1 Antibiotic choice however depends on the prevailing local condition such as drug availability, isolated pathogens, risk/ severity of bacterial sepsis, resistance patterns, ease of administration and cost in our environment. Earlier studies have reported a 70 percent mortality if administration of antibiotics (within five hours) is delayed.…”

Prevention of neutropenia during chemotherapy by prolonged myelostimulatory preparations

“…Критерием диагноза ФН является лихорадка (одно-кратный подъем температуры ≥ 38,3 °C или ≥ 38,0 °С в течение > 1 ч) при нейтропении III или IV степени (абсолютное число нейтрофилов < 1,0 или < 0,5 × 10 9 /л). Развитие ФН связано с ухудшением состояния паци-ента и повышением риска смертности, как правило, требует госпитализации и лечения антибиотиками, тем самым значительно увеличивая стоимость лечения [1][2][3][4][5] и снижая качество жизни больных. В исследо-вании Н. Кудерер и соавт.…”