Risk of mortality in patients with cancer who experience febrile neutropenia

Abstract

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.

Surveillance of Healthcare-Associated Infections Rates in Hematology-Oncology Patients

“…Despite advances in oncology care, infections remain a major cause of morbidity and mortality among patients with hematologic malignancies, resulting in high length of stay and healthcare costs [1][2][3][4]. The estimated incidence density of healthcare-associated infections (HAIs) ranges from 11 to 21.8 per 1,000 patients-days [5][6][7].…”

Evaluation of the Use of Granulocyte Colony-Stimulating Factors (G-CSFs) for Neutropenia Primary Prophylaxis in Solid Tumors at a Tertiary Care Hospital, Retrospective Study

“…Febrile neutropenia (FN) is a serious and life-threatening condition that may increase hospitalization due to fever and potentially fatal infections after chemotherapy [1,2]. The National Comprehensive Cancer Network (NCCN) defines FN as a single oral temperature of ≥ 38.3°C ( ≥ 100.9°F) or sustained 38.0°C ( ≥ 100.4°F) for 1 hour and an absolute neutrophil count of<500 neutrophils/ mm³ or <1000 neutrophils/mm³ with a predicted decline to <500 neutrophils/mm³ over the following 48 h [3].…”

Epidemiology and characteristics of febrile neutropenia in oncology patients from Spanish tertiary care hospitals: PINNACLE study

“…A retrospective analysis of breast cancer patients revealed that the survival rate was 40% in those receiving ≥85% of the chemotherapy dose, whereas the rate decreased to 21% in patients receiving <85% of the dose (10). While dose reductions in palliative treatment may result in lower rates of tumor response, to the detriment of the patient's quality of life, dose reduction in curative or adjuvant therapies may be associated with an increased risk for disease recurrence and death (11)(12)(13). Prophylactic treatment with granulocyte colony-stimulating factor (G-CSF) was found to be beneficial regarding patient survival and a reduction in the risk of FN (14)(15)(16).…”