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Population-based Assessment of Hospitalizations for Neutropenia from Chemotherapy in Older Adults with Non-Hodgkin’s Lymphoma (United States)

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Abstract

Objective

To study neutropenia hospitalization (NH) incidence and risk factors in a population-based sample of older adults with non-Hodgkin’s lymphoma (NHL) and evaluate the validity of inferences from Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases.

Methods

NHL cases receiving first-course chemotherapy were identified from Iowa SEER-Medicare. Survival methods evaluated NH risk factors. Medical record and Medicare claims data on chemotherapy and NH were compared.

Results

Of 761 subjects, 165 (21.7%, 95% CI: 18.8, 24.6) were hospitalized for neutropenia. Of those hospitalized, 41% were hospitalized in cycle 1 and 22% in cycle 2. Significant multivariable risk factors for NH were diffuse large cell histology, renal disease, Charlson comorbidity index, and anthracycline chemotherapy but not patient age. Medicare and medical records agreed on month of chemotherapy initiation 95% of the time and chemotherapy type 95% of the time. ICD-9 code 288.0 sensitivity for NH was 80%.

Conclusions

Neutropenia hospitalizations were common in the first 2 chemotherapy cycles, especially among older adults with comorbidity. Findings conflict with a prior medical records study in which age was a risk factor for NH and dose intensity a negative confounder. Valid inferences about age effects on chemotherapy toxicity require more clinical detail than is available in administrative data.

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Acknowledgements

This study was funded by an unrestricted research grant from Amgen, Inc.

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

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Authors and Affiliations

  1. Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA

    Shari Chen-Hardee, Elizabeth A. Chrischilles, Margaret D. Voelker & John M. Brooks

  2. Health Effectiveness Research Center, The University of Iowa, Iowa City, IA, USA

    Shari Chen-Hardee, Elizabeth A. Chrischilles, Margaret D. Voelker, John M. Brooks, Shane Scott & Brian K. Link

  3. Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, USA

    Elizabeth A. Chrischilles, John M. Brooks, Shane Scott & Brian K. Link

  4. College of Pharmacy, The University of Iowa, Iowa City, IA, USA

    John M. Brooks

  5. College of Medicine, The University of Iowa, Iowa City, IA, USA

    Shane Scott & Brian K. Link

  6. Amgen Inc., Thousand Oaks, CA, USA

    David Delgado

Authors
  1. Shari Chen-Hardee
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  2. Elizabeth A. Chrischilles
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  3. Margaret D. Voelker
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  4. John M. Brooks
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  5. Shane Scott
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  6. Brian K. Link
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  7. David Delgado
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Corresponding author

Correspondence to Elizabeth A. Chrischilles.

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Chen-Hardee, S., Chrischilles, E.A., Voelker, M.D. et al. Population-based Assessment of Hospitalizations for Neutropenia from Chemotherapy in Older Adults with Non-Hodgkin’s Lymphoma (United States). Cancer Causes Control 17, 647–654 (2006). https://doi.org/10.1007/s10552-005-0502-4

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  • DOI: https://doi.org/10.1007/s10552-005-0502-4

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