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Trends in the use of primary prophylactic colony-stimulating factors and neutropenia-related hospitalization in elderly cancer patients receiving myelosuppressive chemotherapy in the USA: 1995–2015



To assess changes in neutropenia-related hospitalization, myelosuppressive chemotherapy, and primary prophylactic colony-stimulating factor (PP-CSF) use in elderly cancer patients receiving myelosuppressive chemotherapy.


We identified annual cohorts of patients aged ≥ 66 years with breast cancer, lung cancer, or non-Hodgkin lymphoma (NHL) initiating myelosuppressive chemotherapy during 1995–2015 using Medicare 5% (1994–2008) and 20% (2007–2015) data. We described myelosuppressive chemotherapy changes by febrile neutropenia (FN) risk category (high, intermediate, unclassified), PP-CSF use, and, in the first cycle of myelosuppressive chemotherapy, neutropenia-related hospitalization (ICD-9-CM: 288.0X, first 5 positions). We evaluated hospitalization trends using a logistic regression model with spline curve of calendar year adjusting for baseline characteristics.


Annual cohorts included 1451–2114 eligible patients for 1995–2007 and 5272–7603 for 2008–2015. Myelosuppressive chemotherapy use with high/intermediate FN risk increased from 31% in 1995 to 56% in 1999, stabilized through 2008 (range 56–61%), then decreased to 52% in 2015. PP-CSF use increased from 5.5% in 1995 to 52.7% in 2015, mainly due to pegfilgrastim introduction in 2002. Crude neutropenia-related hospitalization incidence decreased from 5.2% in 1995 to 2.7% in 2015; adjusted incidence decreased, on average, by 4.7% yearly before 2010 (p < 0.0001) and was flat from 2010 onward (p = 0.53).


Among elderly patients with breast cancer, lung cancer, or NHL receiving myelosuppressive chemotherapy, PP-CSF use increased substantially after 2002. Neutropenia-related hospitalization incidence in the first cycle decreased yearly before 2010 and was flat afterward. Further studies are needed to understand overall decreasing neutropenia-related hospitalization trends and effects of changes in myelosuppressive chemotherapy and FN management.

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


This study was financially supported by the Amgen Inc.

Author information




Research idea and study design: SL, JL, PG, CK, MB, DC; data acquisition: SL, JL, HG; data analysis/interpretation: HG, JL, SL, PG, CK, MB, DC; statistical analysis: HG, JL; supervision or mentorship: SL, JL. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work.

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Correspondence to Shuling Li.

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Shuling Li, Jiannong Liu, and Haifeng Guo are employees of Chronic Disease Research Group, Hennepin Healthcare Research Institute, which has received project funding from Amgen Inc. Prasad L. Gawade, Christopher Kim, Mark E. Bensink, and David Chandler are employees of and own stock in Amgen Inc.

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Li, S., Liu, J., Guo, H. et al. Trends in the use of primary prophylactic colony-stimulating factors and neutropenia-related hospitalization in elderly cancer patients receiving myelosuppressive chemotherapy in the USA: 1995–2015. Support Care Cancer 28, 2637–2649 (2020).

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  • Colony-stimulating factors
  • Febrile neutropenia
  • Medicare
  • Neutropenia-related hospitalization