title: Use of Hematopoietic Growth Factors and Risk of Thromboembolic and Pulmonary Toxicities in Elderly Patients with Advanced Ovarian Cancer.
abstract: To evaluate the risk of thromboembolic and pulmonary toxicities associated with hematopoietic growth factor (HGF) use (i.e., erythropoietin-stimulating agent [ESA] and/or colony-stimulating factor [CSF]) in a community-dwelling cohort of elderly patients with advanced ovarian cancer.
  
  
  
  We studied 8,188 women, 65 years and older from the Surveillance, Epidemiology and End Results-Medicare linked database, diagnosed from January 1, 2000 to December 31, 2009. Patients were categorized into five groups: no chemotherapy and no ESA/CSF (n = 2,616), chemotherapy but no ESA/CSF (n = 1,854), ESA only (n = 1,313), CSF only (n = 743), and ESA + CSF (n = 1,662). We reported the cumulative incidence of toxicities for 2, 6, and greater than 6 months, and the incidence density for the overall follow-up. Cox-proportional hazards regression was performed to determine risk of toxicities.
  
  
  
  Of the 5,572 patients receiving chemotherapy, 66.7% (n = 3,718) received HGF supportive treatment, 29.8% received ESA + CSF, 23.6% received ESA only, and 13.3% received CSF only. Patients who received chemotherapy and also ESA + CSF had a 14.1% cumulative incidence of thromboembolic event (TEE) at 6 months of follow-up compared with 8.0% in those who received chemotherapy without growth factor and 3.2% in those with neither chemotherapy nor growth factor. Those with chemotherapy who received ESA + CSF had a significantly higher risk of TEE (adjusted hazard ratio, 1.22; 95% confidence interval, 1.01-1.47) as compared with patients with chemotherapy and no ESA/CSF, although patients aged 85 years and older may experience up to a five-fold increased risk. The risk of pulmonary toxicities did not significantly differ by HGF use.
  
  
  
  An increased risk of TEEs was observed in elderly patients with ovarian cancer who received ESA + CSF. The risk-benefit ratio for administering HGF should be carefully evaluated, especially among those 85 years and older.
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center Houston - School of Public Health, Houston, Texas.
authors.forename: Insiya B
authors.initials: IB
authors.lastname: Poonawalla
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center Houston - School of Public Health, Houston, Texas.
authors.forename: Linda B
authors.initials: LB
authors.lastname: Piller
authors.affiliation: Department of Management Policy and Community Health, University of Texas Health Science Center Houston - School of Public Health, Houston, Texas.
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.affiliation: Department of Biostatistics, University of Texas Health Science Center Houston - School of Public Health, Houston, Texas.
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Epidemiology, Human Genetics, and Environmental Science, University of Texas Health Science Center Houston - School of Public Health, Houston, Texas. Electronic address: Xianglin.L.Du@uth.tmc.edu.
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003115:Colony-Stimulating Factors / Q000009:adverse effects* / Q000627:therapeutic use*; D004921:Erythropoietin / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D006278:Medicare; D010051:Ovarian Neoplasms / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013923:Thromboembolism / Q000139:chemically induced*; D014481:United States
chemical_list: D003115:Colony-Stimulating Factors; D004921:Erythropoietin; C100266:erythrogenin