Febrile Neutropenia Costly Problem in Metastatic Cancer

Risk for febrile neutropenia was high among patients with metastases from a variety of common cancers and was associated with numerous clinical and economic consequences, including increased morbidity and mortality, according to the results of a recent study.

“To our knowledge, our study is the largest and broadest evaluation to date of the risk and consequences of chemotherapy-induced febrile neutropenia among patients with metastatic solid tumors in US clinical practice,” wrote Derek Weycker, PhD,  of Policy Analysis (PAI), and colleagues in the Journal of Oncology Practice.

Weycker and colleagues used data from two large private health plans providing coverage to more than 30 million people annually. Data were collected from 2006 to 2011 and included adults who underwent myelosuppressive chemotherapy for metastatic breast (n = 15,309), colorectal (n = 16,934), lung (n = 21,994), ovarian (n = 7,435), or prostate cancer (n = 4,668).

Among patients included, the most common courses of treatment were paclitaxel (18%) for metastatic breast cancer; oxaliplatin, fluorouracil, and leucovorin (23%) for metastatic colorectal cancer; carboplatin plus paclitaxel (23%) for metastatic lung cancer; carboplatin plus paclitaxel (49%) for metastatic ovarian cancer; and docetaxel (68%) for metastatic prostate cancer.

The incidence of febrile neutropenia varied from 13% among patients with metastatic ovarian cancer to 21% among patients with metastatic lung cancer, and occurred most often in the first cycle of treatment.

The researchers found that febrile neutropenia resulted in hospitalization for between 89% and 94% of cases. Median hospital stay due to febrile neutropenia was consistent, ranging from 7 days for metastatic breast cancer to 7.5 days for metastatic colorectal cancer. In contrast, hospital mortality ranged from 3.9% for ovarian cancer to 10.3% for lung cancer.

The researchers also calculated the costs associated with febrile neutropenia. Results showed that total cost ranged from $16,291 for patients with metastatic prostate cancer to $19,456 for patients with metastatic ovarian cancer.

“The estimated cost of a febrile neutropenia episode may not reflect the full impact of this condition, because patients who develop febrile neutropenia in one cycle have been found to be at elevated risk of febrile neutropenia in subsequent cycles, and costs occurring in subsequent cycles that might be related to the initial episode were not captured in our study,” the researchers wrote.

Weycker and colleagues also noted that the analysis included in the study may not fully capture the consequences associated with febrile neutropenia, as it did not include “dose delays and reductions, early termination of planned chemotherapy, and increased antimicrobial use, all of which may lead to suboptimal patient outcomes.”