Advertisement

Febrile neutropenia-related care and associated costs in elderly patients with breast cancer, lung cancer, or non-Hodgkin lymphoma

  • Shuling LiEmail author
  • Jiannong Liu
  • Charles Bowers
  • Tamer A. F. S. Garawin
  • Christopher Kim
  • Mark E. Bensink
  • David B. Chandler
Original Article

Abstract

Purpose

Limited information is available regarding elderly patients experiencing febrile neutropenia (FN). This study evaluated FN-related care among elderly cancer patients who received high/intermediate FN-risk chemotherapy and experienced ≥ 1 FN episodes.

Methods

We used Medicare data to identify patients aged ≥ 66 years who initiated high/intermediate FN-risk chemotherapy between 1 January 2008 and 31 August 2015 to treat breast cancer (BC), lung cancer (LC), or non-Hodgkin lymphoma (NHL) and had ≥ 1 FN episodes. We identified within-cycle FN episodes for each chemotherapy cycle on Part A inpatient claims or outpatient or Part B claims. We described the FN-related care setting (inpatient hospital, outpatient emergency department [ED], or outpatient non-ED) and reported mean total cost of FN-related care per episode overall and by care setting (adjusted to 2015 US$).

Results

We identified 2138, 3521, and 2862 patients with BC, LC, and NHL, respectively, with ≥ 1 FN episodes (total episodes: 2407, 3840, 3587, respectively). Most FN episodes required inpatient care (BC, 88.1%; LC, 93.0%; NHL, 93.2%) with mean hospital length of stay (LOS) 6.2, 6.5, and 6.8 days, respectively. Intensive care unit admission was required for 20.4% of BC, 29.0% of LC, and 25.7% of NHL hospitalizations (mean LOS: 4.7, 4.7, 5.5 days, respectively). The mean total cost of FN care per episode was $11,959 BC, $14,388 LC, and $15,006 NHL, with inpatient admission the costliest care component ($11,826; $14,294; and $14,873; respectively).

Conclusions

Among elderly patients with BC, LC, or NHL who experienced FN, most FN episodes required costly hospital care, highlighting the FN burden on healthcare systems.

Keywords

Chemotherapy Elderly patients Febrile neutropenia Healthcare costs Medicare 

Notes

Acknowledgments

Medical writing support was provided by Martha Mutomba (on behalf of Amgen Inc.) and Micah Robinson (of Amgen Inc.). The authors thank Chronic Disease Research Group colleague Nan Booth for manuscript editing.

Funding

This study was supported by Amgen, Inc.

Compliance with ethical standards

Conflict of interest

Shuling Li and Jiannong Liu are employees of Chronic Disease Research Group, Hennepin Healthcare Research Institute, which has received project funding from Amgen, Inc. Charles Bowers, Tamer A. F. S. Garawin, Christopher Kim, Mark E. Bensink, and David B. Chandler are employees of and own stock in Amgen, Inc.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Formal consent was not required as the article does not contain any studies involving human participants performed by any of the authors.

Supplementary material

520_2019_4795_MOESM1_ESM.docx (24 kb)
ESM 1 (DOCX 23 kb)

References

  1. 1.
    Lyman GH, Dale DC, Crawford J (2003) Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: a nationwide study of community practices. J Clin Oncol 21:4524–4531CrossRefGoogle Scholar
  2. 2.
    Lyman GH, Dale DC, Friedberg J, Crawford J, Fisher RI (2004) Incidence and predictors of low chemotherapy dose-intensity in aggressive non-Hodgkin’s lymphoma: a nationwide study. J Clin Oncol 22:4302–4311CrossRefGoogle Scholar
  3. 3.
    Lyman GH (2009) Impact of chemotherapy dose intensity on cancer patient outcomes. J Natl Compr Cancer Netw 7:99–108CrossRefGoogle Scholar
  4. 4.
    Shayne M, Culakova E, Poniewierski MS, Wolff D, Dale DC, Crawford J, Lyman GH (2007) Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy. Cancer 110:1611–1620CrossRefGoogle Scholar
  5. 5.
    Shayne M, Culakova E, Wolff D, Poniewierski MS, Dale DC, Crawford J, Lyman GH (2009) Dose intensity and hematologic toxicity in older breast cancer patients receiving systemic chemotherapy. Cancer 115:5319–5328CrossRefGoogle Scholar
  6. 6.
    Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106:2258–2266CrossRefGoogle Scholar
  7. 7.
    Lyman GH, Michels SL, Reynolds MW, Barron R, Tomic KS, Yu J (2010) Risk of mortality in patients with cancer who experience febrile neutropenia. Cancer 116:5555–5563CrossRefGoogle Scholar
  8. 8.
    Schilling MB, Parks C, Deeter RG (2011) Costs and outcomes associated with hospitalized cancer patients with neutropenic complications: a retrospective study. Exp Ther Med 2:859–866CrossRefGoogle Scholar
  9. 9.
    Lyman GH, Kuderer NM (2003) Epidemiology of febrile neutropenia. Support Cancer Ther 1:23–35CrossRefGoogle Scholar
  10. 10.
    Lyman GH, Kuderer NM, Crawford J, Wolff DA, Culakova E, Poniewierski MS, Dale DC (2011) Predicting individual risk of neutropenic complications in patients receiving cancer chemotherapy. Cancer 117:1917–1927CrossRefGoogle Scholar
  11. 11.
    Lyman GH, Abella E, Pettengell R (2014) Risk factors for febrile neutropenia among patients with cancer receiving chemotherapy: a systematic review. Crit Rev Oncol Hematol 90:190–199CrossRefGoogle Scholar
  12. 12.
    Dulisse B, Li X, Gayle JA, Barron RL, Ernst FR, Rothman KJ, Legg JC, Kaye JA (2013) A retrospective study of the clinical and economic burden during hospitalizations among cancer patients with febrile neutropenia. J Med Econ 16:720–735CrossRefGoogle Scholar
  13. 13.
    Michels SL, Barron RL, Reynolds MW, Smoyer Tomic K, Yu J, Lyman GH (2012) Costs associated with febrile neutropenia in the US. Pharmacoeconomics 30:809–823CrossRefGoogle Scholar
  14. 14.
    United States Department of Labor Website. CPI Inflation Calculator. Bureau of Labor Statistics. Available at: https://www.bls.gov/data/inflation_calculator.htm. Accessed 22 Feb 2019
  15. 15.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Myeloid growth factors. V1.2018. Available at: http://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf. Accessed 22 Feb 2019
  16. 16.
    Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C, EOfR, Cancer To (2011) 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 47:8–32CrossRefGoogle Scholar
  17. 17.
    de Naurois J, Novitzky-Basso I, Gill MJ, Marti FM, Cullen MH, Roila F, Group EGW (2010) Management of febrile neutropenia: ESMO clinical practice guidelines. Ann Oncol 21(Suppl 5):v252–v256CrossRefGoogle Scholar
  18. 18.
    Smith TJ, Bohlke K, Armitage JO (2015) Recommendations for the use of white blood cell growth factors: American Society of Clinical Oncology clinical practice guideline update. J Oncol Pract 11:511–513CrossRefGoogle Scholar
  19. 19.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines®). Older adult oncology. Version 1.2018. Available at: http://www.nccn.org/professionals/physician_gls/pdf/senior.pdf. Accessed 22 Feb 2019
  20. 20.
    Morrison VA, Picozzi V, Scott S, Pohlman B, Dickman E, Lee M, Lawless G, Kerr R, Caggiano V, Delgado D, Fridman M, Ford J, Carter WB, Group OPPSW (2001) The impact of age on delivered dose intensity and hospitalizations for febrile neutropenia in patients with intermediate-grade non-Hodgkin’s lymphoma receiving initial CHOP chemotherapy: a risk factor analysis. Clin Lymphoma 2:47–56CrossRefGoogle Scholar
  21. 21.
    Laskey RA, Poniewierski MS, Lopez MA, Hanna RK, Secord AA, Gehrig PA, Lyman GH, Havrilesky LJ (2012) Predictors of severe and febrile neutropenia during primary chemotherapy for ovarian cancer. Gynecol Oncol 125:625–630CrossRefGoogle Scholar
  22. 22.
    Li Y, Klippel Z, Shih X, Reiner M, Wang H, Page JH (2016) Relationship between severity and duration of chemotherapy-induced neutropenia and risk of infection among patients with nonmyeloid malignancies. Support Care Cancer 24:4377–4383CrossRefGoogle Scholar
  23. 23.
    Lyman GH, Lyman CH, Agboola O (2005) Risk models for predicting chemotherapy-induced neutropenia. Oncologist 10:427–437CrossRefGoogle Scholar
  24. 24.
    Zimmer AJ, Freifeld AG (2019) Optimal management of neutropenic fever in patients with cancer. J Oncol Pract 15:19–24CrossRefGoogle Scholar
  25. 25.
    Weycker D, Li X, Tzivelekis S, Atwood M, Garcia J, Li Y, Reiner M, Lyman GH (2017) Burden of chemotherapy-induced febrile neutropenia hospitalizations in US clinical practice, by use and patterns of prophylaxis with colony-stimulating factor. Support Care Cancer 25:439–447CrossRefGoogle Scholar
  26. 26.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN Guidelines®). Myeloid growth factors. 2015. Available at: http://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf. Accessed 22 Feb 2019
  27. 27.
    Weycker D, Sofrygin O, Seefeld K, Deeter RG, Legg J, Edelsberg J (2013) Technical evaluation of methods for identifying chemotherapy-induced febrile neutropenia in healthcare claims databases. BMC Health Serv Res 13:60CrossRefGoogle Scholar
  28. 28.
    Weycker D, Hanau A, Lonshteyn A, Bowers C, Garawin T, Bensink M, Chandler D (2018) Risk of chemotherapy-induced febrile neutropenia with early discontinuation of pegfilgrastim prophylaxis: a retrospective evaluation using Medicare claims. Curr Med Res Opin 34:1–6CrossRefGoogle Scholar
  29. 29.
    Weycker D, Li X, Barron R, Li Y, Reiner M, Kartashov A, Figueredo J, Tzivelekis S, Garcia J (2016) Risk of chemotherapy-induced febrile neutropenia with early discontinuation of pegfilgrastim prophylaxis in US clinical practice. Support Care Cancer 24:2481–2490CrossRefGoogle Scholar
  30. 30.
    Centers for Medicare & Medicaid Services. CMS.gov. Market Basket Data. Actual regulation market basket change and Medicare payment updates as published in the “Federal Register”. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/MarketBasketData.html. Accessed 22 Feb 2019
  31. 31.
    Chindaprasirt J, Wanitpongpun C, Limpawattana P, Thepsuthammarat K, Sripakdee W, Sookprasert A, Wirasorn K (2013) Mortality, length of stay, and cost associated with hospitalized adult cancer patients with febrile neutropenia. Asian Pac J Cancer Prev 14:1115–1119CrossRefGoogle Scholar
  32. 32.
    Wang XJ, Wong M, Hsu LY, Chan A (2014) Costs associated with febrile neutropenia in solid tumor and lymphoma patients - an observational study in Singapore. BMC Health Serv Res 14:434CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shuling Li
    • 1
    Email author
  • Jiannong Liu
    • 1
  • Charles Bowers
    • 2
  • Tamer A. F. S. Garawin
    • 2
  • Christopher Kim
    • 2
  • Mark E. Bensink
    • 2
  • David B. Chandler
    • 2
  1. 1.Chronic Disease Research GroupHennepin Healthcare Research InstituteMinneapolisUSA
  2. 2.Amgen Inc.Thousand OaksUSA

Personalised recommendations