BACKGROUNDHospitalization for febrile neutropenia (FN) in cancer patients is associated with considerable morbidity, mortality, and cost. The study was undertaken to better define mortality, length of stay (LOS), cost, and risk factors associated with mortality and prolonged hospitalization in cancer patients with FN.METHODSThe longitudinal discharge database derived from 115 US medical centers was used to study all adult cancer patients hospitalized with FN between 1995 and 2000, comprising a total of 41,779 patients. Primary outcomes included mortality, LOS, and cost per episode.RESULTSOverall, in‐hospital mortality was 9.5%. Patients without any major comorbidities had a 2.6% risk of mortality, whereas 1 major comorbidity was associated with a 10.3% and more than 1 major comorbidity with a ≥21.4% risk of mortality, respectively. Mean (median) length of stay was 11.5 (6) days, and the mean (median) cost was $19,110 ($8,376) per episode of FN. Patients hospitalized for ≥10 days (35% of all patients) accounted for 78% of overall cost. Independent major risk factors for inpatient mortality included invasive fungal infections, Gram‐negative sepsis, pneumonia and other lung disease, cerebrovascular, renal, and liver disease. Main predictors for LOS ≥10 days included leukemia, invasive fungal infections, other types of infection, and several comorbid conditions.CONCLUSIONFactors associated with increased mortality, LOS, and cost in hospitalized adult cancer patients with FN include patient characteristics, type of malignancy, comorbidities, and infectious complications. These factors may be useful in identifying patients at increased risk of serious medical complications and mortality for more aggressive supportive care measures. Cancer 2006. © 2006 American Cancer Society.

Stability, robustness, and security issues arising from future self‐organizing networks (SONs) must be understood today, in order to be incorporated into their design, standardization, and certification. We address the issue of operator trust in Long Term Evolution (LTE) SON through the following five requirements and outline our approaches to meet them: 1) trust must be measurable, 2) trust must be SON‐specific, 3) trust must be model‐driven, 4) trust must be propagated end‐to‐end, and 5) trust must be certified. As such, we consider the three facets of operator trust—reliable operation, trustworthy interworking, and seamless deployment and suggest a composite metric for SON stability; we define a key performance indicator (KPI)‐based envelope of dependable adaptations; we demonstrate how to construct such models based on predicates; we show that trust networks emerge from predicate‐enabled behaviors; and we outline the certification process. Trust predicates that are defined at the design phase as abstract behaviors, and verified at runtime as fully qualified ones, prove to have the power of policies. Once checked, they can be reused many times, and rewritten to cater to new behaviors. © 2012 Alcatel‐Lucent.

BACKGROUND The incidence of venous thromboembolism (VTE) is increased in cancer, but little information is available about risk factors in cancer patients on chemotherapy. METHODS We analyzed data from a prospective, multicenter observational study to determine the frequency and risk factors for VTE in ambulatory cancer patients initiating a new chemotherapy regimen. The association of VTE with clinical variables was characterized using univariate and multivariate analysis. RESULTS Among 3003 patients treated with at least one cycle of chemotherapy, VTE occurred in 58 (1.93%) over a median follow‐up of 2.4 months (0.8%/mo). The incidence varied significantly by site of cancer (P = 0.01) with highest rates in upper gastrointestinal (2.3%/mo) and lung cancer (1.2%/mo), and lymphoma (1.1%/mo). An elevated prechemotherapy platelet count was significantly associated with an increased rate of VTE (P for trend = 0.005). The incidence of VTE was 3.98% (1.66%/mo) for patients with a prechemotherapy platelet count ≥ 350,000, compared with 1.25% (0.52%/mo) for patients with platelet counts of < 200,000 (P for trend=0.0003). In multivariate analysis, a prechemotherapy platelet count of ≥ 350,000/mm3 (adjusted OR 2.81, 95% CI 1.63–4.93, P = 0.0002), site of cancer, hemoglobin < 10g/dL or use of erythropoietin, and use of white cell growth factors in high‐risk sites of cancer were significantly associated with VTE. CONCLUSIONS Symptomatic VTE is a frequent complication of chemotherapy. The prechemotherapy platelet count is a unique risk factor and can help identify high‐risk patients for future trials of thromboprophylaxis. Cancer 2005. © 2005 American Cancer Society.

Cytotoxic chemotherapy suppresses the hematopoietic system, impairing host protective mechanisms and limiting the doses of chemotherapy that can be tolerated. Neutropenia, the most serious hematologic toxicity, is associated with the risk of life-threatening infections as well as chemotherapy dose reductions and delays that may compromise treatment outcomes. The authors reviewed the recent literature to provide an update on research in chemotherapy-induced neutropenia and its complications and impact, and they discuss the implications of this work for improving the management of patients with cancer who are treated with myelosuppressive chemotherapy. Despite its importance as the primary dose-limiting toxicity of chemotherapy, much concerning neutropenia and its consequences and impact remains unknown. Recent surveys indicate that neutropenia remains a prevalent problem associated with substantial morbidity, mortality, and costs.Much research has sought to identify risk factors that may predispose patients to neutropenic complications, including febrile neutropenia, in an effort to predict better which patients are at risk and to use preventive strategies, such as prophylactic colony-stimulating factors, more cost-effectively. Neutropenic complications associated with myelosuppressive chemotherapy are a significant cause of morbidity and mortality, possibly compromised treatment outcomes, and excess healthcare costs. Research in quantifying the risk of neutropenic complications may make it possible in the near future to target patients at greater risk with appropriate preventive strategies, thereby maximizing the benefits and minimizing the costs.

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.