title: Risk of Neutropenia-Related Hospitalization in Patients Who Received Colony-Stimulating Factors With Chemotherapy for Breast Cancer.
abstract: Purpose To describe outcomes after granulocyte colony-stimulating factor (G-CSF) prophylaxis in patients with breast cancer who received chemotherapy regimens with low-to-intermediate risk of induction of neutropenia-related hospitalization. Patients and Methods We identified 8,745 patients age ≥ 18 years from a medical and pharmacy claims database for 14 commercial US health plans. This retrospective analysis included patients with breast cancer who began first-cycle chemotherapy from 2008 to 2013 using docetaxel and cyclophosphamide (TC); docetaxel, carboplatin, and trastuzumab (TCH); or doxorubicin and cyclophosphamide (conventional-dose AC) regimens. Primary prophylaxis (PP) was defined as G-CSF administration within 5 days of beginning chemotherapy. Outcome was neutropenia, fever, or infection-related hospitalization within 21 days of initiating chemotherapy. Multivariable regressions and number-needed-to-treat analyses were used. Results A total of 4,815 patients received TC (2,849 PP; 1,966 no PP); 2,292 patients received TCH (1,444 PP; 848 no PP); and 1,638 patients received AC (857 PP; 781 no PP) regimen. PP was associated with reduced risk of neutropenia-related hospitalization for TC (2.0% PP; 7.1% no PP; adjusted odds ratio [AOR], 0.29; 95% CI, 0.22 to 0.39) and TCH (1.3% PP; 7.1% no PP; AOR, 0.19; 95% CI, 0.12 to 0.30), but not AC (4.7% PP; 3.8% no PP; AOR, 1.21; 95% CI, 0.75 to 1.93) regimens. For the TC regimen, 20 patients (95% CI, 16 to 26) would have to be treated for 21 days to avoid one neutropenia-related hospitalization; with the TCH regimen, 18 patients (95% CI, 13 to 25) would have to be treated. Conclusion Primary G-CSF prophylaxis was associated with low-to-modest benefit in lowering neutropenia-related hospitalization in patients with breast cancer who received TC and TCH regimens. Further evaluation is needed to better understand which patients benefit most from G-CSF prophylaxis in this setting.
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Abiy
authors.initials: A
authors.lastname: Agiro
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Qinli
authors.initials: Q
authors.lastname: Ma
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Anupama Kurup
authors.initials: AK
authors.lastname: Acheson
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Sze-Jung
authors.initials: SJ
authors.lastname: Wu
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Patt
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Barron
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenberg
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Schilsky
authors.affiliation: Abiy Agiro, Qinli Ma, Sze-jung Wu, and John J. Barron, HealthCore, Wilmington, DE; Anupama Kurup Acheson, Providence Cancer Center, Portland, OR; Debra A. Patt, Texas Oncology, Austin; Debra A. Patt, The US Oncology Network, Houston, TX; Jennifer L. Malin, Anthem, Woodland, CA; Alan Rosenberg, Anthem, Chicago, IL; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; and Gary H. Lyman, Hutchinson Institute for Cancer Outcomes Research and University of Washington, Seattle, WA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D016208:Databases, Factual; D000077143:Docetaxel; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000517:prevention & control*; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D000068878:Trastuzumab / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide; D000068878:Trastuzumab