title: Cancer chemotherapy treatment patterns and febrile neutropenia in the US Veterans Health Administration.
abstract: BACKGROUND
  The Veterans Health Administration (VHA) is the largest integrated health care system in the United States and a major cancer care provider.
  
  
  OBJECTIVE
  To use VHA database to conduct a population-based study of patterns of myelosuppressive chemotherapy use and to assess the incidence and management of febrile neutropenia (FN) among VHA patients with lung, colorectal, or prostate cancer or non-Hodgkin lymphoma (NHL).
  
  
  METHODS
  Data were extracted for the initial myelosuppressive chemotherapy course for 27,899 patients who began treatment in the period 2006 to 2011. FN-related costs were defined as claims containing FN diagnosis.
  
  
  RESULTS
  Most patients were men (98.0%); most were 65 years or older (55.8%). Patients received a mean 3.4 to 3.9 chemotherapy cycles/course (median cycle duration 34-43 days). The incidence of FN among patients with lung, colorectal, or prostate cancer or NHL was 10.2%, 4.6%, 5.4%, and 17.3%, respectively. Primary or secondary prophylactic antibiotics/colony-stimulating factors were received by 21% and 12% of patients, respectively. Antibiotics were more commonly given as primary or secondary prophylaxis for patients with lung, colorectal, and prostate cancer; colony-stimulating factors were more common for patients with NHL. Among patients with FN, those with lung cancer had the highest inpatient mortality (10%); patients with NHL had the highest costs ($24,571) and the longest hospital length of stay (15.4 days).
  
  
  CONCLUSIONS
  VHA cancer care was generally consistent with National Comprehensive Cancer Network recommendations; however, compared with the general population, chemotherapy cycles were longer, combination chemotherapy was used less, and treatment to prevent FN was used less, differences that may be attributed to the unique VHA patient population. The impact of these practices warrants further investigation.
authors.affiliation: STATinMED Research, Plano, TX.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Amgen, Inc., Thousand Oaks, CA.
authors.forename: Richard
authors.initials: R
authors.lastname: Barron
authors.affiliation: STATinMED Research, Plano, TX; MEF University, Istanbul, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.affiliation: Amgen, Inc., Thousand Oaks, CA.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Langeberg
authors.affiliation: University of Washington, Seattle, WA. Electronic address: dcdale@u.washington.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Dale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D016208:Databases, Factual / Q000639:trends; D064147:Febrile Neutropenia / Q000139:chemically induced* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D058014:Veterans Health / Q000639:trends*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Veterans Health Administration; chemotherapy; febrile neutropenia; supportive care