title: Burden of Chemotherapy-Induced Febrile Neutropenia Hospitalizations in US Clinical Practice, by Use and Patterns of Prophylaxis with Colony-Stimulating Factor.
abstract: Evidence suggests that many cancer chemotherapy patients who are candidates for colony-stimulating factor (CSF) prophylaxis do not receive it or receive it inconsistent with guidelines, and that such patients have a higher risk of febrile neutropenia hospitalization (FNH). Little is known about the number and consequences of FNH by use/patterns of CSF prophylaxis in US clinical practice.
  
  
  
  A retrospective cohort design and private healthcare claims data were employed. Study population comprised adults who received a chemotherapy course with a high-risk regimen, or an intermediate-risk regimen (if ≥1 FN risk factor present), for non-metastatic breast cancer or non-Hodgkin's lymphoma (NHL); each chemotherapy cycle within the course and each FNH episode within the cycles were identified. Consequences included mortality, inpatient days, and costs (US$2013) during FNH. Use (yes/no) and patterns (agent, administration day/duration) of CSF prophylaxis were evaluated within cycles in which FNH episodes occurred.
  
  
  
  Among all FNH episodes (n=6,355; 109 episodes per 1,000 patients), 41.3% (95% CI: 40.1-42.5) occurred among patients who did not receive CSF prophylaxis in that cycle, and 8.8% (8.1-9.5) occurred among those who received CSF prophylaxis on the same day as chemotherapy. Among FNH episodes occurring in patients who received daily CSF agents (2% of CSF use), 56.1% (44.1-68.0) received prophylaxis <7 days during the cycle. Results for FNH consequences were comparable.
  
  
  
  In this retrospective evaluation, one-half of FNH episodes, outcomes, and costs among cancer chemotherapy patients who were candidates for CSF prophylaxis occurred in those who either did not receive it or received it inconsistent with guidelines.
authors.affiliation: Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA. dweycker@pai2.com.
authors.forename: Derek
authors.initials: D
authors.lastname: Weycker
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Li
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Spiros
authors.initials: S
authors.lastname: Tzivelekis
authors.affiliation: Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Atwood
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Garcia
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Yanli
authors.initials: Y
authors.lastname: Li
authors.affiliation: Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Reiner
authors.affiliation: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D003115:Colony-Stimulating Factors / Q000008:administration & dosage*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003115:Colony-Stimulating Factors; D016179:Granulocyte Colony-Stimulating Factor
keywords: Breast cancer; Febrile neutropenia; Filgrastim; Granulocyte colony-stimulating factor; Non-Hodgkin’s lymphoma; Pegfilgrastim; Sargramostim