History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF prophylaxis
Menée aux Etats-Unis auprès de 19 160 participants (âge moyen : 60 ans), cette étude de cohorte analyse l'association entre diverses comorbidités chroniques et le risque de neutropénie fébrile chez des patients atteints d'un cancer (lymphome non hodgkinien, sein, côlon-rectum, poumon, ovaire, estomac) et traités par chimiothérapie
Résumé en anglais
Background : Chemotherapy-induced febrile neutropenia (FN) is a clinically important complication that impacts patient outcome by delaying chemotherapy doses or reducing dose intensity. Risk of FN depends on chemotherapy- and patient-level factors. We sought to determine the effects of chronic comorbidities on risk of FN.
Design : We conducted a cohort study to examine the association between a variety of chronic comorbidities and risk of FN in patients diagnosed with six types of cancer (non-Hodgkin lymphoma and breast, colorectal, lung, ovary, and gastric cancer) from 2000-2009 who were treated with chemotherapy at Kaiser Permanente Southern California, a large managed care organization. We excluded those patients who received primary prophylactic granulocyte colony-stimulating factor. History of comorbidities and FN events were identified using electronic medical records. Cox models adjusting for propensity score, stratified by cancer type, were used to determine the association between comorbid conditions and FN. Models that additionally adjusted for cancer stage, baseline neutrophil count, chemotherapy regimen, and dose reduction were also evaluated.
Results : A total of 19,160 patients with mean age of 60 years were included; 963 (5.0%) developed FN in the first chemotherapy cycle. Chronic obstructive pulmonary disease [HR=1.30 (1.07-1.57)], congestive heart failure [HR=1.43 (1.00-1.98)], HIV infection [HR=3.40 (1.90-5.63)], autoimmune disease [HR=2.01 (1.10-3.33)], peptic ulcer disease [HR=1.57 (1.05-2.26)], renal disease [HR=1.60 (1.21-2.09)], and thyroid disorder [HR=1.32 (1.06-1.64)] were all associated with a significantly increased FN risk.
Conclusions : These results provide evidence that history of several chronic comorbidities increase risk of FN, which should be considered when managing patients during chemotherapy.
