Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia

Abstract

Objective:To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer.Methods: Linked data from New South Wales population-based and clinical cancer registries (2008)(2009)(2010)(2011)(2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18 years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6 months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods.Results: A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1).Conclusion: Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols.Further examination of reasons for admission is needed to inform actions to improve patient safety. K E Y W O R D Sadjuvant, antineoplastic agents, breast neoplasms, chemotherapy, drug-related side effects and adverse reactions, hospitalisation, survival

Febrile neutropenia incidence and the variable toxicity profile between brand and generic docetaxel in the adjuvant treatment of breast cancer with docetaxel and cyclophosphamide regimen

“…( 1 - 3 ) The decision to use adjuvant treatment depends on pathological features such as tumor size, grade, histological subtype, lymph node involvement, and lymphovascular invasion. ( 1 - 2 ) For uncertain cases, personalized tumor genetic analysis tests such as Oncotype DX ® and MammaPrint ® can help determine individual recurrence risk and predict the potential benefit of adjuvant chemotherapy. ( 1 , 4 , 5 )…”

“…In selecting a treatment regimen, it is essential to consider the tumor’s pathological and clinical characteristics and the patient’s age, performance status, comorbidities, previous treatments, and the possible side effects associated with treatment. ( 2 , 5 , 6 ) In an attempt to minimize side effects, taxanes have replaced anthracyclines for patients at intermediate risk (early breast cancer, hormone receptor-positive with an indication for chemotherapy based on pathological risk or assessed via genetic testing). The combination of docetaxel and cyclophosphamide (TC) is superior to the combination of doxorubicin and cyclophosphamide (AC).…”