asco@alo33:161787
|
Background: Several risk factors for febrile neutropenia FN have been identified in previous studies eg, chemotherapy [chemo] dose intensity, advanced age, and comorbidities . The possible biological mechanisms underlying these risk factors include bone marro suppression, impaired neutrophil function, and disturbances of barrier function andor the microbiome. We assessed additional factors that might affect FN risk via these mechanisms, including select dermatologic, mucosal and open-ound conditions, recent surgery, recentconcurrent radiation, and recent antibiotic and corticosteroid use. Methods: We retrospectively evaluated medical records of members of Kaiser Permanentes Southern California Health Plan ho ere diagnosed ith non-Hodgkins lymphoma or lung, gastric, ovarian, colorectal, or female breast cancer beteen 2000 and 2009 and ere treated ith chemo. Patients ho received prophylactic G-CSF or antibiotics ere excluded. Multivariable Cox models ere used to evaluate association beteen FN and potential risk factors in the first chemo cycle. Potential confounders demographicclinicalchemo ere adjusted using natural cubic spline functions of propensity scores as covariates. Results: Of the 16,956 patients included in this analysis, 68.4 percent ere female, 61.8 percent ere hite, and mean age at cancer diagnosis as 60.4 years. In the first chemo cycle, 719 patients 4.2 percent developed FN. Hazard ratios for association of FN risk ith nely proposed risk factors are shon in the Table. Conclusions: Recent dermatologic conditions that might affect skin integrity and corticosteroid use increased FN risk and should be considered in managing patients treated ith chemo. ltcaption class=mtgabstract-table-title Association of FN risk ith ne risk factors.Risk FactorHazard Ratio 95 percent CI Recent dermatologic conditions x2264;1 moa 1.56 1.033, 2.244 Recent corticosteroids x2264;3 moa 1.52 1.219, 1.877 Concurrent radiation x2264;5 db 1.55 0.776, 2.892 Recent mucosal conditions x2264;1 moa 1.36 0.724, 2.312 Recent surgery x2264;1 moa 1.19 0.996, 1.414 Recent open-ound x2264;1 moa 1.12 0.442, 2.276 Recent antibiotics x2264;3 moa 1.04 0.898, 1.211 Recent radiation x2264;2 moa 0.88 0.612, 1.224 ltfn id=TF-161787-001-1 ltp class=mtgabstract-table-fn a Months before chemo start. b Days after chemo start.lttable-rap-foot ,J Clin Oncol 34, 2016 suppl; abstr 6559 00:00.0,Health Services Research and Quality of Care
|