title: A prospective investigation of chemotherapy-induced neutropenia and quality of life.
abstract: This prospective study of chemotherapy-induced neutropenia (CIN) explored the association between the relative grade of neutropenia and symptom burden and quality of life (QOL). Eighty-four adult cancer patients from nine community oncology centers receiving 1 of 13 myelosuppressive chemotherapies were evaluated at days 0, 4, 7, 9, 11, 14, and 21 of their respective first cycle. Neutropenia grade (grade 3/4 vs grades 0 to 2) was determined by serial absolute neutrophil count (ANC) measures. Measures of patient-reported outcomes included the Rotterdam Symptom Checklist (RSCL), Hospital Anxiety and Depression Scale (HADS), Cancer Care Monitor-Medical Isolation Scale (CCM-MIS), and SF-36. Changes in outcomes from baseline to highest grade of neutropenia were evaluated using mixed model-repeated measures for each of 15 outcomes. Compared with grades 0-2, grade 3/4 neutropenia was associated with greater symptom burden and worse QOL for six measures (P < 0.05). The pattern of differences suggested that measures of symptom distress and social functioning were sensitive to patient changes associated with grade 3/4 neutropenia. Worsening of symptom burden and QOL appears to be associated with severe afebrile neutropenia. A causal relationship between neutropenia and worse symptoms and QOL remains difficult to establish due to the confounding of the effects of neutropenia with other adverse effects of chemotherapy.
authors.affiliation: Accelerated Community Oncology Research Network, Supportive Oncology Services, Inc., Memphis, Tennessee 38138, USA.
authors.forename: Barry V
authors.initials: BV
authors.lastname: Fortner
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Houts
authors.forename: Lee S
authors.initials: LS
authors.lastname: Schwartzberg
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001007:Anxiety / Q000209:etiology; D016190:Carboplatin / Q000009:adverse effects; D002945:Cisplatin / Q000009:adverse effects; D003520:Cyclophosphamide / Q000009:adverse effects; D003863:Depression / Q000209:etiology; D000077143:Docetaxel; D004317:Doxorubicin / Q000009:adverse effects; D015251:Epirubicin / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D011241:Prednisone / Q000009:adverse effects; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D012044:Regression Analysis; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D043823:Taxoids / Q000009:adverse effects; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014750:Vincristine / Q000009:adverse effects
chemical_list: D043823:Taxoids; D000077143:Docetaxel; D015251:Epirubicin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil; D011241:Prednisone