Although the researchers observed improvements upon incorporating several new comorbidities into the risk factors for chemotherapy-induced febrile neutropenia, the improvements were small and may not be clinically relevant.
The incorporation of several new comorbidities into the established risk factors for febrile neutropenia is associated with a better prediction of the risk of febrile neutropenia during the first cycle of chemotherapy, according to new study findings. However, the improvements seen are small and may not be clinically relevant, the researchers warned.
In 2011, a febrile neutropenia risk model based on data from community-based oncology practices across the country listed patient age, type of cancer, previous chemotherapy, and low white blood cell count as factors. risk of neutropenia and febrile neutropenia. Recently, comorbidities such as HIV, diabetes (in non-obese patients), congestive heart failure, rheumatoid conditions, and thyroid disorders have been reported to be associated with the risk of developing the disease.
Chemotherapy-induced febrile neutropenia often results in hospitalization and other side effects, as well as significant health costs. With the risk of developing febrile neutropenia depending on chemotherapy regimens, patient characteristics and disease characteristics, treatment with granulocyte colony stimulating factor (G-CSF) may mitigate these risks.
Clinical guidelines recommend primary prophylaxis with G-CSF in patients receiving high-risk chemotherapy regimens and recommend that this be considered for patients receiving intermediate-risk chemotherapy regimens who have additional risk factors.
“Therefore, febrile neutropenia risk prediction tools integrating patient and disease characteristics for individual patients could inform the clinical use of G-CSF,” the study researchers wrote.
To determine the effectiveness of the tools for predicting the risk of neutropenia, the researchers developed a new risk model for febrile neutropenia taking into account the newly identified comorbidities and compared the new model to the 2011 model. The researchers included 15,279 patients. adults diagnosed with cancer and treated with chemotherapy at Kaiser Permanente Southern California between 2000 and 2009. Patients were split evenly into training and validation data sets.
The area under the receptor operating characteristic curve (AUROCC), risk reclassification, and integrated discrimination improvement were used to assess potential improvement in febrile neutropenia risk prediction by incorporating co-morbidities.
During the first cycle of chemotherapy, 4.2% of patients developed febrile neutropenia. The researchers observed no improvement in AUROCC in the new model compared to the reference model, and the addition of comorbidities resulted in only a slight increase in the number of patients classified in the correct risk categories for febrile neutropenia.
The analysis crossed the predicted risk with the reference model, the predicted risk with the new model and the observed risk of febrile neutropenia. Across the entire patient population, the new model provided a more accurate risk classification for 6% of patients. However, the model provided a less precise risk classification for 5% of patients.
Of the 317 patients in the validation set who developed febrile neutropenia, the new model improved classification in 8.8% of patients but worsened classification in 7.3% of patients. Of the 7322 patients who did not develop febrile neutropenia, the new model improved the risk classification for 5.6% of the patients but worsened the classification in 5.1% of the patients.
Li Y, Family L, Chen L, et al. Benefit of integrating newly identified risk factors in predicting the risk of chemotherapy-induced febrile neutropenia [published online June 28, 2018]. Cancer Med. doi: 10.1002 / cam4.1580.