title: History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF prophylaxis.
abstract: BACKGROUND
  Chemotherapy-induced febrile neutropenia (FN) is a clinically important complication that affects patient outcome by delaying chemotherapy doses or reducing dose intensity. Risk of FN depends on chemotherapy- and patient-level factors. We sought to determine the effects of chronic comorbidities on risk of FN.
  
  
  METHODS
  We conducted a cohort study to examine the association between a variety of chronic comorbidities and risk of FN in patients diagnosed with six types of cancer (non-Hodgkin lymphoma and breast, colorectal, lung, ovary, and gastric cancer) from 2000 to 2009 who were treated with chemotherapy at Kaiser Permanente Southern California, a large managed care organization. We excluded those patients who received primary prophylactic granulocyte colony-stimulating factor. History of comorbidities and FN events were identified using electronic medical records. Cox models adjusting for propensity score, stratified by cancer type, were used to determine the association between comorbid conditions and FN. Models that additionally adjusted for cancer stage, baseline neutrophil count, chemotherapy regimen, and dose reduction were also evaluated.
  
  
  RESULTS
  A total of 19 160 patients with mean age of 60 years were included; 963 (5.0%) developed FN in the first chemotherapy cycle. Chronic obstructive pulmonary disease [hazard ratio (HR) = 1.30 (1.07-1.57)], congestive heart failure [HR = 1.43 (1.00-1.98)], HIV infection [HR = 3.40 (1.90-5.63)], autoimmune disease [HR = 2.01 (1.10-3.33)], peptic ulcer disease [HR = 1.57 (1.05-2.26)], renal disease [HR = 1.60 (1.21-2.09)], and thyroid disorder [HR = 1.32 (1.06-1.64)] were all associated with a significantly increased FN risk.
  
  
  CONCLUSIONS
  These results provide evidence that history of several chronic comorbidities increases risk of FN, which should be considered when managing patients during chemotherapy.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena. Electronic address: chun.r.chao@kp.org.
authors.forename: C
authors.initials: C
authors.lastname: Chao
authors.affiliation: Center for Observational Research, Amgen, Inc., Thousand Oaks.
authors.forename: J H
authors.initials: JH
authors.lastname: Page
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: S-J
authors.initials: SJ
authors.lastname: Yang
authors.affiliation: Department of Hematology Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles.
authors.forename: R
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: Department of Hematology and Oncology, Harbor-UCLA Medical Center, Los Angeles, USA.
authors.forename: J
authors.initials: J
authors.lastname: Huynh
authors.affiliation: Center for Observational Research, Amgen, Inc., Thousand Oaks.
authors.forename: V M
authors.initials: VM
authors.lastname: Chia
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000453:epidemiology; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor
keywords: cancer; chemotherapy; comorbidities; febrile neutropenia; neutropenia; toxicity