Risk and Timing of Neutropenic Events in Adult Cancer Patients Receiving Chemotherapy: The Results of a Prospective Nationwide Study of Oncology Practice

Authors:
Jeffrey Crawford From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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David C. Dale From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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Nicole M. Kuderer From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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Eva Culakova From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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Marek S. Poniewierski From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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Debra Wolff From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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Gary H. Lyman From Duke University, Durham, North Carolina, and University of Washington, Seattle, Washington.

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 MD, MPH
Volume/Issue:
Volume 6: Issue 2
Online Publication Date:
Feb 2008
DOI:
https://doi.org/10.6004/jnccn.2008.0012
Full access

This study was undertaken to describe the relationship between the occurrence and timing of neutropenic events and chemotherapy treatment in a community-based population of patients with cancer. The study included 2962 patients with breast, lung, colorectal, lymphoma, and ovarian cancers from a prospective U.S. registry of patients initiating a new chemotherapy regimen. Detailed patient-, disease-, and treatment-related data, including toxicities, were captured at baseline, the beginning of each cycle, and each midcycle blood draw for up to 4 cycles of treatment. Primary outcomes included febrile neutropenia (FN), severe neutropenia without fever/infection, and relative dose intensity (RDI). Thirty-seven percent of patients were aged 65 years or older, 43.5% had an Eastern Cooperative Oncology Group performance status of 1 or greater, and 27% had 1 or more comorbidities. Reductions in RDI to less than 85% of standard in the first cycle were planned in 23.6% of patients, whereas primary colony-stimulating factor prophylaxis was used in 18.2%. In the first 3 cycles of treatment, 10.7% of patients experienced FN, with most of these events (58.9%) occurring in the first cycle. This first-cycle pattern was consistently observed despite wide variations in event rates by tumor type, disease stage, chemotherapy regimen and dose, and patient characteristics. Despite frequent planned reductions from standard RDI, the incidence of FN remains high in community oncology practice in the United States. Improved methods of pretreatment assessment of patient risk factors for neutropenia are needed.

Correspondence: Gary H Lyman, MD, MPH, Duke University Medical Center, DUMC Box 3645, Durham, NC 27710. E-mail: Gary.Lyman@Duke.edu
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2008 by the National Comprehensive Cancer Network
Page Numbers:
10
Article Category:
Research Article
Received:
23 May 2007
Accepted:
06 Aug 2007
Print Publication Date:
01 Feb 2008
Online Publication Date:
Feb 2008
Keywords:
Neutropenia; fever; infection; chemotherapy; cancer

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