Patterns of chemotherapy-associated toxicity and supportive care in US oncology practice: a nationwide prospective cohort study.
Bottom Line: Neutropenic complications remain an important dose-limiting toxicity of cancer chemotherapy-associated with considerable morbidity, mortality, and cost.Chemotherapy-associated toxicities were captured in up to four treatment cycles including severe neutropenia, febrile neutropenia, and infection.A significant inverse relationship was observed between reductions in neutropenic and infectious events and increased utilization of measures to reduce these complications in subsequent cycles.
Affiliation: Duke University, Durham, North Carolina.Show MeSH
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Mentions: The highest occurrence of neutropenic and infectious events occurred in cycle 1 (Fig. 1) with a substantial decrease seen in subsequent cycles. FN events decreased from 6.4% in cycle 1 to 3.8% and 2.9% in cycles 2 and 3, respectively. In comparison, compound events of febrile and/or severe neutropenia (FN/SN) decreased from 20% in cycle 1 to 14% in cycle 2 and stayed approximately stable at this lower level with 13.5% and 14.3% in cycles 3 and 4, respectively. This decreasing trend of neutropenic events in subsequent cycles was uniformly noted in patients with lymphoma, early-stage solid tumors, or stage IV solid tumors. However, the incidence of FN/SN events in each cycle was influenced by cancer type and disease stage, with first cycle neutropenic event rates of 23.8% in lymphoma, 22.6% in stage I–III solid tumors, and 13.1% in stage IV solid tumors. Similarly, during the subsequent cycles (2, 3, and 4), lower occurrences of FN/SN were observed in patients with stage IV solid tumors (9.2%, 9.8%, 7.8%) compared to patients with stage I–III solid tumors (16.6%, 14.4%, 16.3%) or lymphoma (15.0%, 16.2%, 16.3%). Febrile and infectious events followed a comparable trend.