Risk of Febrile Neutropenia among Patients with Intermediate-grade non-Hodgkin's Lymphoma Receiving CHOP Chemotherapy

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225

154

BACKGROUND: Febrile neutropenia (FN) is a serious and potentially life-threatening condition that may develop in patients with cancer who receive myelosuppressive chemotherapy. The risk of mortality from FN is not well characterized in current clinical practice. METHODS: Patients with cancer who were receiving chemotherapy in clinical practice were identified from a large US healthcare claims database, and mortality was confirmed using the National Death Index. Patients with FN had their propensity scores matched within tumor types of interest (non-Hodgkin lymphoma and breast, lung, colorectal, and ovarian cancers) to patients who did not experience FN. Study endpoints of overall mortality (anytime during follow-up), early mortality (during the first 12 months of the first chemotherapy course), and hospitalization were examined using univariate and multivariate techniques. RESULTS: Matched FN and control groups each included 5990 patients, and the average follow-up for both groups was 17.6 months. Crude incidence rates of early mortality were significantly higher for patients with FN compared with controls for all tumor types. Proportional hazards regression demonstrated a significant increase in the risk of overall and early mortality in patients with FN compared with controls (hazard ratio [HR], 1.15 [95% confidence interval, 1.02-1.29] and HR, 1.35 [95% confidence interval, 1.09-1.67], respectively). CONCLUSIONS: The adjusted risk of mortality in patients who experienced FN was at least 15% higher than in comparably matched patients without FN, supporting the inference that infectious complications because of neutropenia resulting from myelosuppressive chemotherapy are clinically important.

Section: Fn and Early Mortalitymentioning

confidence: 99%

Risk of mortality in patients with cancer who experience febrile neutropenia

Lyman

Michels²,

Reynolds³

et al. 2010

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225

154

“…In addition, previous risk modeling studies have suggested an association between greater than 80% ARDI and increased risk of a febrile neutropenic event. 8,9 Hospitalization for febrile neutropenia was determined from the patient's medical record. Time to first hospitalization for febrile neutropenia was defined as the number of days from the start of Cycle 1 chemotherapy to the day that the first hospitalization for febrile neutropenia occurred.…”

Section: Treatment Characteristics and Outcomesmentioning

confidence: 99%

“…In addition, to our knowledge, none of these models have been validated. [7][8][9][10][11] Furthermore, previous risk modeling efforts have provided limited information regarding the risk and timing of the first hospitalization for febrile neutropenia.…”

mentioning

confidence: 99%

Risk and timing of hospitalization for febrile neutropenia in patients receiving CHOP, CHOP‐R, or CNOP chemotherapy for intermediate‐grade non‐Hodgkin lymphoma

Lyman

Delgado

2003

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171

111

BACKGROUNDHospitalization for chemotherapy‐induced febrile neutropenia is associated with substantial cost and may negatively impact clinical outcome due to associated dose attenuation.METHODSMedical records of 1355 patients with intermediate‐grade non‐Hodgkin lymphoma receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or similar chemotherapy were reviewed. The potential risk factors associated with first hospitalization for febrile neutropenia were evaluated.RESULTSIn the current study, 230 patients (17%) experienced 1 or more hospitalizations for febrile neutropenia and greater than one‐half of all initial hospitalizations for febrile neutropenia occurred in Cycles 1 or 2. Increased risk of hospitalization for febrile neutropenia, based on Cox proportional hazards models, was significantly associated with the following characteristics: age 65 years or older (hazard ratio [HR] = 1.79; 95% confidence interval [95% CI], 1.35–2.37), serum albumin level at presentation less than or equal to 3.5 g/dL (HR = 1.34; 95% CI, 1.01–1.78), planned average relative dose intensity greater than or equal to 80% (HR = 2.70; 95% CI, 1.47–4.98), baseline absolute neutrophil count less than 1500/mm3 (HR = 1.98; 95% CI, 1.28–3.06), and the presence of hepatic disease (HR = 2.18; 95% CI, 1.11–4.28). Lack of early granulocyte colony‐stimulating factor in Cycles 1 and 2 was also associated with increased risk of hospitalization for febrile neutropenia, but this did not reach statistical significance. A composite risk score based on these potential risk factors effectively distinguished patients at greater risk of hospitalization for febrile neutropenia (P < 0.001), the majority of which were observed during the first cycle of chemotherapy.CONCLUSIONSThe data from the current study demonstrated that the risk of initial hospitalization for febrile neutropenia occured early in the course of CHOP‐like chemotherapy. Identified risk factors for febrile neutropenia hospitalization may facilitate the use of targeted supportive care. Cancer 2003. © 2003 American Cancer Society.

“…[5][6][7] These dose modifications often are implemented during the first cycles of chemotherapy, because neutropenic events often occur early during the course of chemotherapy. 8,9 Treatment response frequently depends on the delivery of standard chemotherapy doses, and modifications in dosing may threaten complete response rates and reduce survival. 10 -15 Thus, caregivers face a challenge in maintaining adequate chemotherapeutic doses while managing neutropenic complications.…”

mentioning

confidence: 99%

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

Caggiano

Weiss²,

Rickert³

et al. 2005

299

219

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.