Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy
BACKGROUND. This prospective study was undertaken to evaluate patient and treatment characteristics that contribute to hematologic toxicity in older cancer patients. METHODS. A nationwide study of 115 community oncology practices was conducted between 2002 and 2005 with data collected on 976 patient...
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| Veröffentlicht in: | Cancer 2007-10, Vol.110 (7), p.1611-1620 |
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| creator | Shayne, Michelle Culakova, Eva Poniewierski, Marek S. Wolff, Debra Dale, David C. Crawford, Jeffrey Lyman, Gary H. |
| description | BACKGROUND.
This prospective study was undertaken to evaluate patient and treatment characteristics that contribute to hematologic toxicity in older cancer patients.
METHODS.
A nationwide study of 115 community oncology practices was conducted between 2002 and 2005 with data collected on 976 patients who had received chemotherapy for common malignancies, including lung cancer, colorectal cancer, breast cancer, ovarian cancer, genitourinary cancer, and lymphoma. Primary outcomes included severe neutropenia (SN) and febrile neutropenia (FN). Secondary outcomes included delivered relative dose intensity (RDI) |
| doi_str_mv | 10.1002/cncr.22939 |
| format | Article |
| fullrecord | <record><control><sourceid>wiley_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1002_cncr_22939</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>CNCR22939</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4239-dbe839a08fcec9f14dcf011529b8835d68fc863a90867cec82c1f9c22f3b918c3</originalsourceid><addsrcrecordid>eNp90EtLxDAQB_AgiruuXvwA0osXoWse7TY5Sn3CoiAK3mo6TXcjbVqS-Oi3N2sX9uZpCPPLTPJH6JTgOcGYXoIBO6dUMLGHpgSLLMYkoftoijHmcZqwtwk6cu4jHDOaskM0IVmGUyKyKXq_7pyKtPHKOO2HSJoqWqtW-q7pVhoi3_1o2DS0ibqmUjYCaSCUXnqtjHeRVaD0lzaryA3OqzZcgjCh82tlZT8co4NaNk6dbOsMvd7evOT38fLp7iG_WsaQUCbiqlScCYl5DQpETZIKakxISkXJOUurRWjwBZMC80UWCKdAagGU1qwUhAOboYtxLtjOOavqore6lXYoCC42MRWbmIq_mAI-G3H_Wbaq2tFtLgGcb4F0IJvahk9rt3PhGTRJWHBkdN-6UcM_K4v8MX8el_8CGGeCHQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Shayne, Michelle ; Culakova, Eva ; Poniewierski, Marek S. ; Wolff, Debra ; Dale, David C. ; Crawford, Jeffrey ; Lyman, Gary H.</creator><creatorcontrib>Shayne, Michelle ; Culakova, Eva ; Poniewierski, Marek S. ; Wolff, Debra ; Dale, David C. ; Crawford, Jeffrey ; Lyman, Gary H.</creatorcontrib><description>BACKGROUND.
This prospective study was undertaken to evaluate patient and treatment characteristics that contribute to hematologic toxicity in older cancer patients.
METHODS.
A nationwide study of 115 community oncology practices was conducted between 2002 and 2005 with data collected on 976 patients who had received chemotherapy for common malignancies, including lung cancer, colorectal cancer, breast cancer, ovarian cancer, genitourinary cancer, and lymphoma. Primary outcomes included severe neutropenia (SN) and febrile neutropenia (FN). Secondary outcomes included delivered relative dose intensity (RDI) <85%, dose delays ≥15% days, and reductions ≥15%.
RESULTS.
Approximately 50% of both patients with early‐stage disease and patients with advanced‐stage disease received an actual RDI <85%, and this rate reached 60% in the oldest group (aged >80 years). Increasing age was associated with lower actual RDI (P = .030) and averaged 87.5% across all elderly age groups. A decreasing trend in SN or FN events occurred with increasing age (P for trend = .039), with the majority of initial neutropenic events occurring in Cycle 1 for all age groups. Among the patients who received an actual RDI ≥85%, there was no significant difference in SN or FN by age group or disease stage. Independent risk factors for the development of SN or FN included cancer type, planned RDI ≥85%, body surface area ≤2m2, anthracycline‐ or platinum‐based regimens, previous chemotherapy, elevated blood urea nitrogen, and alkaline phosphatase. Neutropenic complications decreased significantly with primary colony‐stimulating factor (CSF) prophylaxis (coefficient of determination [R2] = 0.260; c‐statistic = 0.782).
CONCLUSIONS.
Among cancer patients aged ≥70 years, 50% of whom received relatively full‐dose chemotherapy, increasing age alone did not increase the risk of hematologic toxicity. Cancer 2007. © 2007 American Cancer Society.
The results from this prospective study of 976 patients age ≥70 years who received chemotherapy revealed that nearly 50% received substantial reductions in delivered chemotherapy dose intensity. Among patients who received the full dose intensity, there was no significant difference in neutropenic complications by age. Risk factors for neutropenic events included type of cancer, regimen, planned dose intensity, previous chemotherapy, and abnormal chemistries and decreased with prophylactic colony‐stimulating factor. Increasing age alone did not appear to increase the risk of hematologic toxicity.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.22939</identifier><identifier>PMID: 17705197</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; aging, colony‐stimulating factor, dose intensity, dose, neutropenic complications ; Antineoplastic Combined Chemotherapy Protocols - administration & dosage ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Biological and medical sciences ; Disease-Free Survival ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Granulocyte Colony-Stimulating Factor - therapeutic use ; Granulocyte-Macrophage Colony-Stimulating Factor - therapeutic use ; Hematologic and hematopoietic diseases ; Humans ; Logistic Models ; Male ; Medical sciences ; Multivariate Analysis ; Neoplasm Staging ; Neoplasms - drug therapy ; Neoplasms - pathology ; Neutropenia - chemically induced ; Neutropenia - prevention & control ; Other diseases. Hematologic involvement in other diseases ; Prospective Studies ; Severity of Illness Index ; Tumors</subject><ispartof>Cancer, 2007-10, Vol.110 (7), p.1611-1620</ispartof><rights>Copyright © 2007 American Cancer Society</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4239-dbe839a08fcec9f14dcf011529b8835d68fc863a90867cec82c1f9c22f3b918c3</citedby><cites>FETCH-LOGICAL-c4239-dbe839a08fcec9f14dcf011529b8835d68fc863a90867cec82c1f9c22f3b918c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.22939$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.22939$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19082443$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17705197$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shayne, Michelle</creatorcontrib><creatorcontrib>Culakova, Eva</creatorcontrib><creatorcontrib>Poniewierski, Marek S.</creatorcontrib><creatorcontrib>Wolff, Debra</creatorcontrib><creatorcontrib>Dale, David C.</creatorcontrib><creatorcontrib>Crawford, Jeffrey</creatorcontrib><creatorcontrib>Lyman, Gary H.</creatorcontrib><title>Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND.
This prospective study was undertaken to evaluate patient and treatment characteristics that contribute to hematologic toxicity in older cancer patients.
METHODS.
A nationwide study of 115 community oncology practices was conducted between 2002 and 2005 with data collected on 976 patients who had received chemotherapy for common malignancies, including lung cancer, colorectal cancer, breast cancer, ovarian cancer, genitourinary cancer, and lymphoma. Primary outcomes included severe neutropenia (SN) and febrile neutropenia (FN). Secondary outcomes included delivered relative dose intensity (RDI) <85%, dose delays ≥15% days, and reductions ≥15%.
RESULTS.
Approximately 50% of both patients with early‐stage disease and patients with advanced‐stage disease received an actual RDI <85%, and this rate reached 60% in the oldest group (aged >80 years). Increasing age was associated with lower actual RDI (P = .030) and averaged 87.5% across all elderly age groups. A decreasing trend in SN or FN events occurred with increasing age (P for trend = .039), with the majority of initial neutropenic events occurring in Cycle 1 for all age groups. Among the patients who received an actual RDI ≥85%, there was no significant difference in SN or FN by age group or disease stage. Independent risk factors for the development of SN or FN included cancer type, planned RDI ≥85%, body surface area ≤2m2, anthracycline‐ or platinum‐based regimens, previous chemotherapy, elevated blood urea nitrogen, and alkaline phosphatase. Neutropenic complications decreased significantly with primary colony‐stimulating factor (CSF) prophylaxis (coefficient of determination [R2] = 0.260; c‐statistic = 0.782).
CONCLUSIONS.
Among cancer patients aged ≥70 years, 50% of whom received relatively full‐dose chemotherapy, increasing age alone did not increase the risk of hematologic toxicity. Cancer 2007. © 2007 American Cancer Society.
The results from this prospective study of 976 patients age ≥70 years who received chemotherapy revealed that nearly 50% received substantial reductions in delivered chemotherapy dose intensity. Among patients who received the full dose intensity, there was no significant difference in neutropenic complications by age. Risk factors for neutropenic events included type of cancer, regimen, planned dose intensity, previous chemotherapy, and abnormal chemistries and decreased with prophylactic colony‐stimulating factor. Increasing age alone did not appear to increase the risk of hematologic toxicity.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>aging, colony‐stimulating factor, dose intensity, dose, neutropenic complications</subject><subject>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Disease-Free Survival</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Granulocyte Colony-Stimulating Factor - therapeutic use</subject><subject>Granulocyte-Macrophage Colony-Stimulating Factor - therapeutic use</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Multivariate Analysis</subject><subject>Neoplasm Staging</subject><subject>Neoplasms - drug therapy</subject><subject>Neoplasms - pathology</subject><subject>Neutropenia - chemically induced</subject><subject>Neutropenia - prevention & control</subject><subject>Other diseases. Hematologic involvement in other diseases</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Tumors</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90EtLxDAQB_AgiruuXvwA0osXoWse7TY5Sn3CoiAK3mo6TXcjbVqS-Oi3N2sX9uZpCPPLTPJH6JTgOcGYXoIBO6dUMLGHpgSLLMYkoftoijHmcZqwtwk6cu4jHDOaskM0IVmGUyKyKXq_7pyKtPHKOO2HSJoqWqtW-q7pVhoi3_1o2DS0ibqmUjYCaSCUXnqtjHeRVaD0lzaryA3OqzZcgjCh82tlZT8co4NaNk6dbOsMvd7evOT38fLp7iG_WsaQUCbiqlScCYl5DQpETZIKakxISkXJOUurRWjwBZMC80UWCKdAagGU1qwUhAOboYtxLtjOOavqore6lXYoCC42MRWbmIq_mAI-G3H_Wbaq2tFtLgGcb4F0IJvahk9rt3PhGTRJWHBkdN-6UcM_K4v8MX8el_8CGGeCHQ</recordid><startdate>20071001</startdate><enddate>20071001</enddate><creator>Shayne, Michelle</creator><creator>Culakova, Eva</creator><creator>Poniewierski, Marek S.</creator><creator>Wolff, Debra</creator><creator>Dale, David C.</creator><creator>Crawford, Jeffrey</creator><creator>Lyman, Gary H.</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley-Liss</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20071001</creationdate><title>Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy</title><author>Shayne, Michelle ; Culakova, Eva ; Poniewierski, Marek S. ; Wolff, Debra ; Dale, David C. ; Crawford, Jeffrey ; Lyman, Gary H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4239-dbe839a08fcec9f14dcf011529b8835d68fc863a90867cec82c1f9c22f3b918c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>aging, colony‐stimulating factor, dose intensity, dose, neutropenic complications</topic><topic>Antineoplastic Combined Chemotherapy Protocols - administration & dosage</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Disease-Free Survival</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Granulocyte Colony-Stimulating Factor - therapeutic use</topic><topic>Granulocyte-Macrophage Colony-Stimulating Factor - therapeutic use</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Multivariate Analysis</topic><topic>Neoplasm Staging</topic><topic>Neoplasms - drug therapy</topic><topic>Neoplasms - pathology</topic><topic>Neutropenia - chemically induced</topic><topic>Neutropenia - prevention & control</topic><topic>Other diseases. Hematologic involvement in other diseases</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shayne, Michelle</creatorcontrib><creatorcontrib>Culakova, Eva</creatorcontrib><creatorcontrib>Poniewierski, Marek S.</creatorcontrib><creatorcontrib>Wolff, Debra</creatorcontrib><creatorcontrib>Dale, David C.</creatorcontrib><creatorcontrib>Crawford, Jeffrey</creatorcontrib><creatorcontrib>Lyman, Gary H.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shayne, Michelle</au><au>Culakova, Eva</au><au>Poniewierski, Marek S.</au><au>Wolff, Debra</au><au>Dale, David C.</au><au>Crawford, Jeffrey</au><au>Lyman, Gary H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2007-10-01</date><risdate>2007</risdate><volume>110</volume><issue>7</issue><spage>1611</spage><epage>1620</epage><pages>1611-1620</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND.
This prospective study was undertaken to evaluate patient and treatment characteristics that contribute to hematologic toxicity in older cancer patients.
METHODS.
A nationwide study of 115 community oncology practices was conducted between 2002 and 2005 with data collected on 976 patients who had received chemotherapy for common malignancies, including lung cancer, colorectal cancer, breast cancer, ovarian cancer, genitourinary cancer, and lymphoma. Primary outcomes included severe neutropenia (SN) and febrile neutropenia (FN). Secondary outcomes included delivered relative dose intensity (RDI) <85%, dose delays ≥15% days, and reductions ≥15%.
RESULTS.
Approximately 50% of both patients with early‐stage disease and patients with advanced‐stage disease received an actual RDI <85%, and this rate reached 60% in the oldest group (aged >80 years). Increasing age was associated with lower actual RDI (P = .030) and averaged 87.5% across all elderly age groups. A decreasing trend in SN or FN events occurred with increasing age (P for trend = .039), with the majority of initial neutropenic events occurring in Cycle 1 for all age groups. Among the patients who received an actual RDI ≥85%, there was no significant difference in SN or FN by age group or disease stage. Independent risk factors for the development of SN or FN included cancer type, planned RDI ≥85%, body surface area ≤2m2, anthracycline‐ or platinum‐based regimens, previous chemotherapy, elevated blood urea nitrogen, and alkaline phosphatase. Neutropenic complications decreased significantly with primary colony‐stimulating factor (CSF) prophylaxis (coefficient of determination [R2] = 0.260; c‐statistic = 0.782).
CONCLUSIONS.
Among cancer patients aged ≥70 years, 50% of whom received relatively full‐dose chemotherapy, increasing age alone did not increase the risk of hematologic toxicity. Cancer 2007. © 2007 American Cancer Society.
The results from this prospective study of 976 patients age ≥70 years who received chemotherapy revealed that nearly 50% received substantial reductions in delivered chemotherapy dose intensity. Among patients who received the full dose intensity, there was no significant difference in neutropenic complications by age. Risk factors for neutropenic events included type of cancer, regimen, planned dose intensity, previous chemotherapy, and abnormal chemistries and decreased with prophylactic colony‐stimulating factor. Increasing age alone did not appear to increase the risk of hematologic toxicity.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>17705197</pmid><doi>10.1002/cncr.22939</doi><tpages>10</tpages></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Free Content; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Age Factors Aged Aged, 80 and over aging, colony‐stimulating factor, dose intensity, dose, neutropenic complications Antineoplastic Combined Chemotherapy Protocols - administration & dosage Antineoplastic Combined Chemotherapy Protocols - adverse effects Biological and medical sciences Disease-Free Survival Dose-Response Relationship, Drug Drug Administration Schedule Female Granulocyte Colony-Stimulating Factor - therapeutic use Granulocyte-Macrophage Colony-Stimulating Factor - therapeutic use Hematologic and hematopoietic diseases Humans Logistic Models Male Medical sciences Multivariate Analysis Neoplasm Staging Neoplasms - drug therapy Neoplasms - pathology Neutropenia - chemically induced Neutropenia - prevention & control Other diseases. Hematologic involvement in other diseases Prospective Studies Severity of Illness Index Tumors |
| title | Dose intensity and hematologic toxicity in older cancer patients receiving systemic chemotherapy |
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