Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients

Abstract

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.

Risk of mortality in patients with cancer who experience febrile neutropenia

“…These findings support previous studies demonstrating that FN in patients who received myelosuppressive chemotherapy had an impact on early mortality. 2 It has long been acknowledged that FN represents the major dose-limiting toxicity of myelosuppressive chemotherapy and often results in prompt hospitalization for evaluation and treatment with empiric, broad-spectrum antimicrobial therapy. A systematic review of RCTs demonstrated that primary prophylaxis with a myeloid growth factor may reduce the risk of infection-related and all-cause early mortality.…”

“…3,[8][9][10] FN is associated with significant morbidity and mortality, with estimates of 6.8% to 20% mortality among patients who are hospitalized for FN-related complications and with higher rates observed in patients who have major comorbidities and documented sepsis or shock. 2,[10][11][12] FN and Late Mortality Despite successful management, FN may have an equally important impact on the overall chemotherapy treatment plan, resulting in dose reductions, treatment delays, chemotherapy discontinuation, or a switch to alternative, less toxic, or potentially less effective regimens. 11,13 Myelosuppression continues to represent the major cause of reduced chemotherapy dose intensity.…”

“…By using both the primary and secondary diagnoses for the receipt of care for an infection, a greater proportion of those truly diagnosed with FN were identified. 2 We used propensity score matching to maximize comparability between the study groups. Within each tumor type of interest, we used logistic regression to compute the propensity to develop FN according to preindex data from all available variables that were predictive of FN (Table 1).…”

F2A sequence linking MGMTP140K and MDR1 in a bicistronic lentiviral vector enables efficient chemoprotection of haematopoietic stem cells

“…2 Moreover, the economical aspect of myelosuppression is very important, for example, hospitalization due to febrile neutropenia led to expenses of more than one billion US dollars during a 5-year period. 3 Thus, an approach for protection of HSCs would be extremely beneficial for the successful treatment of the tumor patient. A very interesting chemoprotective strategy is the gene therapeutic transfer of a resistance gene into HSCs.…”

Pegfilgrastim primary prophylaxis vs. current practice neutropenia management in elderly breast cancer patients receiving chemotherapy

“…In adult cancer patients receiving chemotherapy, febrile neutropenia (FN) is associated with considerable morbidity and in-hospital mortality of up to 10%, the risk of which increases substantially in the presence of comorbidities [1,2]. Furthermore, FN and severe neutropenia are common causes of dose delays and reductions in patients receiving chemotherapy for breast cancer.…”