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How Costly is Febrile Neutropenia in
Patients with Metastatic Cancer?
Febrile neutropenia (FN) is a frequent and often costly
complication for patients with metastatic cancer receiving
myelosuppressive chemotherapy. When patients develop
FN, the likelihood of infection and serious consequences
often necessitates hospitalization for urgent evaluation,
ongoing monitoring, and the use of intravenous antibiotics. It can also have an impact on overall patient care by
causing delays to medication doses or discontinuation of
chemotherapy. This is particularly true for patients with
hematologic malignancies.
According to a retrospective cohort study published in
chemotherapy course ranged from 13.1 percent to 20.6
the Journal of Oncology Practice, FN occurred in up to 21
percent, with lung cancer patients experiencing the greatpercent of metastatic cancer patients studied. Often, these
est frequency of FN (TABLE).
patients required lengthy – and costly – hospitalizations.
FN occurred most often in the first cycle of chemo“Although studies have evaluated the risk and consetherapy and required hospitalization in 89 to 94 percent
quences of febrile neutropenia among patients receiving
of patients depending on cancer type. For those who were
cancer chemotherapy in U.S. clinical practice, none have fohospitalized, mean length of stay ranged from 7.0 days
cused on a broad group of patients with metastatic disease,”
(95% CI 6.7-7.3) for breast cancer patients to 7.5 days (95%
wrote first author Derek Weycker, PhD, and colleagues.
CI 7.2-7.8) for patients with colorectal cancer.
To investigate the prevalence and cost associated with
Hospital mortality, on the other hand, varied widely
FN in patients with metastatic solid tumors, Dr. Weycker
among cancer types: 3.9 percent for ovarian cancer to
and co-authors conducted a large retrospective cohort
10.3 percent for lung cancer.
study of data from two
large private health plans
TABLE. Risk of FN Among Patients with Metastatic Solid Tumors
providing coverage to more
than 30 million people
Chemotherapy
Tumor Type
n
95% CI
annually. The current study
Course
looked at patients underBreast cancer
15,309
15.8%
15.2-16.4
going myelosuppressive
Lung cancer
21,994
20.6%
20.1-21.2
chemotherapy from July
Colorectal cancer
16,934
13.7%
13.2-14.2
2006 to December 2011 for
a tumor in one of five areas:
Ovarian cancer
7,435
13.1%
12.3-13.9
Each episode of febrile
neutropenia led to
significant costs for both
in- and outpatient care.
• 15,309 patients with
breast cancer
Prostate cancer
• 21,994 patients with lung cancer
• 16,934 patients with colorectal cancer
• 7,435 patients with ovarian cancer
• 4,668 patients with prostate cancer
For each patient, the researchers identified the first chemotherapy course and each cycle therein, along with each
episode – if any – of FN experienced during that course.
While there is no specific diagnostic code for febrile
neutropenia in health-care claims databases, the authors
noted, they used an algorithm that combined the various
codes for neutropenia, fever, and infection.
The most common chemotherapy regimens were:
paclitaxel for breast cancer (18%); carboplatin + paclitaxel for lung cancer (23%); oxaliplatin, fluorouracil,
and leucovorin for colorectal cancer (23%); carboplatin
+ paclitaxel for ovarian cancer (49%); and docetaxel for
prostate cancer (68%).
Investigators found that, across the cancers studies,
the percentage of patients who developed FN during their
ASHClinicalNews.org
4,668
17.7%
16.6-18.8
Hospitalization also led to significant costs – from a low
of $16,291per FN episode for patients with prostate cancer
to a high of $19,456 for patients with ovarian cancer.
Each episode of FN also led to increased costs for
those requiring outpatient care only – from $1,550 (95%
CI $1,305-1,846) for patients with lung cancer to $1,769
(95% CI $1,154-2,515) for pat