title: Development and validation of a prediction model for the risk of developing febrile neutropenia in the first cycle of chemotherapy among elderly patients with breast, lung, colorectal, and prostate cancer.
abstract: OBJECTIVE
  Current guidelines recommend prophylactic use of granulocyte-colony stimulating factors (G-CSF) when febrile neutropenia (FN) risk is greater than 20%. Advanced age is a risk factor for FN; however, little is known about the impact of other factors on the incidence of FN in an older population.
  
  
  METHODS
  We analyzed SEER-Medicare data (1994-2005) to develop and validate a prediction model for hospitalization with fever, infection, or neutropenia occurring after chemotherapy initiation for patients with breast, colorectal, prostate, and lung cancer.
  
  
  RESULTS
  In multivariate analysis (N = 58,053) independent predictors of FN included advanced stage at diagnosis [stage 2 (OR 1.29; 95% CI: 1.09-1.53), stage 3 (1.38; 95% CI: 1.19-1.60), and stage 4 (1.57; 95% CI: 1.35-1.83)], number of associated comorbid conditions [one condition (1.13; 95% CI: 1.02-1.28), two conditions (1.39; 95% CI: 1.22-1.57), and three or more conditions (1.81; 95% CI: 1.61-2.04)], receipt of myelosuppressive chemotherapy (1.11; 95% CI: 0.94-1.32), and receipt of chemotherapy within 1 month of diagnosis [1 to 3 months (0.70; 95% CI: 0.62-0.80) and greater than 3 months (0.63; 95% CI: 0.55-0.73)].
  
  
  CONCLUSIONS
  We created a prediction model for febrile neutropenia with first cycle of chemotherapy in a large population of elderly patients with common malignancies.
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Wylie
authors.initials: W
authors.lastname: Hosmer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malin
authors.forename: Mitchell
authors.initials: M
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000517:prevention & control; D005544:Forecasting; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008954:Models, Biological; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology; D009503:Neutropenia / Q000139:chemically induced* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D018426:SEER Program
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor