Limits...
The impact of chemotherapy dose intensity and supportive care on the risk of febrile neutropenia in patients with early stage breast cancer: a prospective cohort study.

Culakova E, Poniewierski MS, Wolff DA, Dale DC, Crawford J, Lyman GH - Springerplus (2015)

Bottom Line: Febrile neutropenia (FN) is a major dose-limiting toxicity of cancer chemotherapy resulting in considerable morbidity, mortality, and cost.There was no significant difference in FN rates by menopausal or hormone receptors status.A decrease in neutropenic events during subsequent cycles is associated with reduced dose intensity or increased use of supportive care measures.

View Article: PubMed Central - PubMed

Affiliation: Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, 1100 Fairview Avenue North, M3-B232, PO Box 19024, Seattle, WA 98109-1024 USA.

ABSTRACT

Background: Febrile neutropenia (FN) is a major dose-limiting toxicity of cancer chemotherapy resulting in considerable morbidity, mortality, and cost. This study evaluated the time course of neutropenic events and patterns of supportive care interventions in patients receiving chemotherapy for early-stage breast cancer treated in oncology community practices.

Methods: A prospective cohort study of adult cancer patients initiating a new chemotherapy regimen was conducted at 115 US sites. Toxicity associated with chemotherapy including neutropenic and infectious complications was recorded over four cycles. Clinical interventions were recorded including reductions in chemotherapy dose intensity and use of supportive care measures.

Results: A total of 1,202 patients with stage I-III breast cancer were evaluated. The majority of neutropenic (116 of 196) and infection events (179 of 325) occurred in the initial cycle. A decrease in occurrence of FN and infection was observed in the subsequent cycles, along with an increase in utilization of colony stimulating factors (CSFs), antibiotics and reductions in chemotherapy dose intensity. The overall risk of FN in all patients was 16.3%. In patients who started treatment at or near full dose intensity, the FN risk reached 21.0% without primary CSF prophylaxis and it was 9.0% with prophylaxis. There was no significant difference in FN rates by menopausal or hormone receptors status.

Conclusions: The risk of neutropenic complications is greatest in the initial cycle when most patients receive full-dose chemotherapy. A decrease in neutropenic events during subsequent cycles is associated with reduced dose intensity or increased use of supportive care measures. However, the cumulative risk of FN remains high in patients with early-stage breast cancer receiving full dose chemotherapy without prophylactic measures.

No MeSH data available.


Related in: MedlinePlus

Neutropenic and infectious events during first 4 cycles. Cycle specific events and cumulative events are presented.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4524886&req=5

Fig1: Neutropenic and infectious events during first 4 cycles. Cycle specific events and cumulative events are presented.

Mentions: Neutropenic and infectious episodes had the highest occurrence during the first cycle of chemotherapy. FN events decreased from 9.7% in cycle 1 to 5.7% and 3.8% in cycles 2 and 3, respectively. Among 196 (16.3%) patients who had a FN event during the treatment, almost 60% (n = 116) experienced the initial event during cycle 1. Overall, 325 (27.0%) patients experienced fever or infection during the observation period and for a majority (179 out of 325) the initial events occurred in cycle 1. Lower rates of infectious events (10.9 and 8.0%) were observed in cycles 2 and 3, respectively, compared to 14.9% in cycle 1. The same patterns were observed for composite events of SN/FN where the incidence fell from 32.1% in cycle 1 to approximately 20% in later cycles. Overall, 529 (44.0%) patients had SN/FN events during the four cycles of chemotherapy and nearly three-quarters experienced their initial event in the first cycle (Fig. 1). The decreasing trend of FN events was observed for pre-menopausal (9.9, 4.7, and 3.3% in cycle 1, 2, and 3, respectively) as well as post-menopausal women (9.6, 6.5, and 4.3% in cycle 1, 2, and 3, respectively) and also for patients with hormone receptor-positive (8.9, 5.2, and 4.0% in cycle 1, 2, and 3, respectively) as well as -negative disease (11.4, 6.7, and 3.3% in cycle 1, 2, and 3, respectively). While the overall incidence of FN did not differ significantly for pre- and post-menopausal women (15.4 vs. 17.1%) or by positive vs. negative hormone receptor status (15.3 vs. 18.1%), the majority of patients in all these subgroups experienced their initial FN during the first cycle. Infectious events and SN/FN events had similar pattern.Fig. 1


The impact of chemotherapy dose intensity and supportive care on the risk of febrile neutropenia in patients with early stage breast cancer: a prospective cohort study.

Culakova E, Poniewierski MS, Wolff DA, Dale DC, Crawford J, Lyman GH - Springerplus (2015)

Neutropenic and infectious events during first 4 cycles. Cycle specific events and cumulative events are presented.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4524886&req=5

Fig1: Neutropenic and infectious events during first 4 cycles. Cycle specific events and cumulative events are presented.
Mentions: Neutropenic and infectious episodes had the highest occurrence during the first cycle of chemotherapy. FN events decreased from 9.7% in cycle 1 to 5.7% and 3.8% in cycles 2 and 3, respectively. Among 196 (16.3%) patients who had a FN event during the treatment, almost 60% (n = 116) experienced the initial event during cycle 1. Overall, 325 (27.0%) patients experienced fever or infection during the observation period and for a majority (179 out of 325) the initial events occurred in cycle 1. Lower rates of infectious events (10.9 and 8.0%) were observed in cycles 2 and 3, respectively, compared to 14.9% in cycle 1. The same patterns were observed for composite events of SN/FN where the incidence fell from 32.1% in cycle 1 to approximately 20% in later cycles. Overall, 529 (44.0%) patients had SN/FN events during the four cycles of chemotherapy and nearly three-quarters experienced their initial event in the first cycle (Fig. 1). The decreasing trend of FN events was observed for pre-menopausal (9.9, 4.7, and 3.3% in cycle 1, 2, and 3, respectively) as well as post-menopausal women (9.6, 6.5, and 4.3% in cycle 1, 2, and 3, respectively) and also for patients with hormone receptor-positive (8.9, 5.2, and 4.0% in cycle 1, 2, and 3, respectively) as well as -negative disease (11.4, 6.7, and 3.3% in cycle 1, 2, and 3, respectively). While the overall incidence of FN did not differ significantly for pre- and post-menopausal women (15.4 vs. 17.1%) or by positive vs. negative hormone receptor status (15.3 vs. 18.1%), the majority of patients in all these subgroups experienced their initial FN during the first cycle. Infectious events and SN/FN events had similar pattern.Fig. 1

Bottom Line: Febrile neutropenia (FN) is a major dose-limiting toxicity of cancer chemotherapy resulting in considerable morbidity, mortality, and cost.There was no significant difference in FN rates by menopausal or hormone receptors status.A decrease in neutropenic events during subsequent cycles is associated with reduced dose intensity or increased use of supportive care measures.

View Article: PubMed Central - PubMed

Affiliation: Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, 1100 Fairview Avenue North, M3-B232, PO Box 19024, Seattle, WA 98109-1024 USA.

ABSTRACT

Background: Febrile neutropenia (FN) is a major dose-limiting toxicity of cancer chemotherapy resulting in considerable morbidity, mortality, and cost. This study evaluated the time course of neutropenic events and patterns of supportive care interventions in patients receiving chemotherapy for early-stage breast cancer treated in oncology community practices.

Methods: A prospective cohort study of adult cancer patients initiating a new chemotherapy regimen was conducted at 115 US sites. Toxicity associated with chemotherapy including neutropenic and infectious complications was recorded over four cycles. Clinical interventions were recorded including reductions in chemotherapy dose intensity and use of supportive care measures.

Results: A total of 1,202 patients with stage I-III breast cancer were evaluated. The majority of neutropenic (116 of 196) and infection events (179 of 325) occurred in the initial cycle. A decrease in occurrence of FN and infection was observed in the subsequent cycles, along with an increase in utilization of colony stimulating factors (CSFs), antibiotics and reductions in chemotherapy dose intensity. The overall risk of FN in all patients was 16.3%. In patients who started treatment at or near full dose intensity, the FN risk reached 21.0% without primary CSF prophylaxis and it was 9.0% with prophylaxis. There was no significant difference in FN rates by menopausal or hormone receptors status.

Conclusions: The risk of neutropenic complications is greatest in the initial cycle when most patients receive full-dose chemotherapy. A decrease in neutropenic events during subsequent cycles is associated with reduced dose intensity or increased use of supportive care measures. However, the cumulative risk of FN remains high in patients with early-stage breast cancer receiving full dose chemotherapy without prophylactic measures.

No MeSH data available.


Related in: MedlinePlus