High Risks, High Costs Associated With Febrile Neutropenia in Metastatic Cancer

Neutropenia is a common complication in patients receiving myelosuppressive chemotherapy that leaves them vulnerable to infectious diseases. Data from 2 large studies of a broad group of over 15,300 patients with metastatic disease who underwent myelosuppressive chemotherapy found that febrile neutropenia occurred in approximately 13% to 21% of patients throughout their course of chemotherapy, typically during their first cycle. The study was published in the Journal of Oncology Practice.

High rates of febrile neutropenia were found in patients with lung and prostate cancers; those with ovarian and colorectal cancers had a lower incidence of febrile neutropenia.

“Overall, for a wide variety of metastatic solid tumors, febrile neutropenia remains a common and adverse effect of myelosuppressive chemotherapy with significant mortality and high economic burden,” the study concluded

The researchers, led by Derek Weycker, PhD, senior health economist at Policy Analysis, Inc, in Brookline, MA, used data from 2006 to 2011 from a large health care claims data base of adult patients who underwent myelosuppressive chemotherapy for one of five major solid tumors: lung cancer, prostate cancer, breast cancer, colorectal cancer, and ovarian cancer.

“Febrile neutropenia was found to be a frequent complication among patients receiving myelosuppressive chemotherapy for metastatic solid tumors in U.S. clinical practice, and among the subset of patients who had a febrile neutropenia episode, the clinical and economic consequences were severe,” Dr Weycker said.

The researchers used an algorithm that combined the various codes for neutropenia, fever, and infection because there was no diagnostic code for febrile neutropenia. There were 25 total unique chemotherapy regimens for metastatic cancer of the breast, 26 for lung, 19 for colon/rectum, 10 for ovarian, and 4 for prostate.

The associated costs of febrile neutropenia were found to range from $16,000 to $19,000 per episode for most hospitalized patients. In addition, hospital mortality was 3.9% to 10.3%, depending on the type of disease.

Patients with lung cancer also had the highest rate of inpatient mortality, at 10.3%. It also most often required hospitalization (89% to 94%), with a mean length of stay of 1 week.

The study received funding support from Amgen.