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Febrile neutropenia and its associated hospitalization in breast cancer patients on docetaxel-containing regimen: A retrospective cohort study on duration of prophylactic GCSF administration

Supportive Care in Cancer volume 28, pages 3801–3812 (2020)Cite this article

Abstract

Purpose

To compare febrile neutropenia (FN) incidence and hospitalization among breast cancer patients on docetaxel with no granulocyte colony-stimulating factors (GCSF) primary prophylaxis (PP), 4/5-day PP, or 7-day PP.

Methods

We identified 3916 breast cancer patients using docetaxel-cyclophosphamide (TC), doxorubicin-cyclophosphamide then docetaxel (AC-T), fluorouracil-epirubicin-cyclophosphamide then docetaxel (FEC-T), docetaxel-carboplatin-trastuzumab (TJH), or docetaxel-doxorubicin-cyclophosphamide (TAC) from a hospital pharmacy dispensing database in Hong Kong between 2014 and 2016. Patients were offered GCSF within 5 days since administering docetaxel. Outcomes included FN incidence, time to first hospitalization, hospitalization rate, and duration.

Results

In TC regimen, FN incidence (with odds ratio, OR) of patients with no PP, 4/5-day PP, and 7-day PP was 21.69%, 7.95% (OR 0.31, p < 0.001), and 5.33% (OR 0.20, p < 0.001), respectively. In TJH regimen, FN incidence of patients with no PP, 4/5-day PP, and 7-day PP was 38.26%, 8.33% (OR 0.15, p < 0.001), and 8.57% (OR 0.15, p < 0.001), respectively. FN incidence of patients on AC-T regimen with no PP and 4/5-day PP was 20.93% and 6.84%, respectively (OR 0.28, p = 0.005); with FEC-T regimen, the incidence was 9.91% and 4.77%, respectively (OR 0.46, p = 0.035). Only 3.27% FN cases were not hospitalized. Mean (±standard deviation, SD) time to first hospitalization was 8.21 ± 2.44 days. Mean (±SD) duration of hospitalization for patients with no PP, 4/5-day PP, and 7-day PP was 4.66 ± 2.60, 4.37 ± 2.85, and 5.12 ± 2.97 days, respectively.

Conclusion

GCSF prophylaxis in breast cancer patients on docetaxel could reduce FN incidence and hospitalization. 4/5-day PP demonstrated similar efficacy to 7-day PP with superior saving benefits on healthcare expenditure.

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Notes

  1. According to Weycker et al., febrile neutropenia was defined as having a diagnostic code of “fever,” “neutropenia,” or “infection,” which is different from the definition of febrile neutropenia adopted in various international guidelines [2, 3, 13].

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Affiliations

  1. School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong

    C. F. Lee & K. Zhou

  2. Department of Pharmacy, Tuen Mun Hospital, Tuen Mun, Hong Kong

    C. F. Lee & W. M. Young

  3. COC Pharmaceutical Service – Oncology Working Group, Hospital Authority, Kowloon, Hong Kong

    W. M. Young, K. Leung, L. K. M. Wong, K. H. So, W. Tang, G. Chong, Y. T. E. Yip & V. Y. M. Ma

  4. Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong

    C. S. Wong, T. Y. Ng & S. F. Lee

  5. Department of Pharmacy, Queen Mary Hospital, Pok Fu Lam, Hong Kong

    K. Leung

  6. Department of Pharmacy, Queen Elizabeth Hospital, Kowloon, Hong Kong

    L. K. M. Wong, M. W. Kwan & H. T. Tsang

  7. Department of Pharmacy, Prince of Wales Hospital, Sha Tin, Hong Kong

    K. H. So

  8. Department of Pharmacy, United Christian Hospital, Kwun Tong, Hong Kong

    W. Tang & G. Chong

  9. Department of Pharmacy, Princess Margaret Hospital, Kwai Chung, Hong Kong

    S. K. Chan & Y. T. E. Yip

  10. Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong

    V. Y. M. Ma, A. Yeung & C. H. Y. Chin

Authors
  1. C. F. Lee
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  2. K. Zhou
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  3. W. M. Young
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  4. C. S. Wong
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  5. T. Y. Ng
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  6. S. F. Lee
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  7. K. Leung
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  8. L. K. M. Wong
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  9. K. H. So
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  10. W. Tang
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  11. G. Chong
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  12. S. K. Chan
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  13. Y. T. E. Yip
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  14. V. Y. M. Ma
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  15. A. Yeung
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  16. C. H. Y. Chin
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  17. M. W. Kwan
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  18. H. T. Tsang
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Contributions

Lee CF, Zhou K, Young WM, Wong CS, Ng TY, and Lee SF are involved with the planning of the investigation. Lee CF, Leung K, Wong LKM, So KH, Tang W, Chong G, Chan SK, Yip YTE, Ma VYM, Yeung A, Chin CHY, Kwan MW, and Tsang HT are involved with data collection. Lee CF also involves in writing manuscript, data interpretation, performing data, and statistical analysis. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to C. F. Lee.

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The authors have no conflicts of interest that are directly relevant to the content of this study.

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Lee, C.F., Zhou, K., Young, W.M. et al. Febrile neutropenia and its associated hospitalization in breast cancer patients on docetaxel-containing regimen: A retrospective cohort study on duration of prophylactic GCSF administration. Support Care Cancer 28, 3801–3812 (2020). https://doi.org/10.1007/s00520-019-05111-6

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  • DOI: https://doi.org/10.1007/s00520-019-05111-6

Keywords

  • Febrile neutropenia
  • Hospitalization
  • Breast cancer
  • Docetaxel
  • GCSF
  • Prophylaxis