Comorbidity Caution for Cancer Chemotherapy

Comorbidities predict the risk of febrile neutropaenia early in chemotherapy

medwireNews: A history of chronic illness increases the risk of febrile neutropaenia (FN) in cancer patients undergoing a first cycle of chemotherapy without prophylactic granulocyte colony-stimulating factor (G-CSF), research shows.

“If confirmed by others, these results may assist FN risk stratification for cancer patients, and should be considered when making decisions regarding treatment choices and the use of prophylactic G-CSF”, say Chun Chao, from Kaiser Permanente Southern California in Pasadena, USA, and co-workers.

Five percent of 19,160 patients treated for non-Hodgkin lymphoma, breast, colorectal, gastric, lung or ovarian cancer between 2000 and 2009 developed FN.

These patients were significantly more likely than patients without FN at first cycle to have chronic obstructive pulmonary disease (COPD; hazard ratio [HR]=1.30), congestive heart failure (HR=1.43), an autoimmune disorder (HR=2.01), peptic ulcer disease (HR=1.57), renal disease (HR=1.60) or a thyroid disorder (HR=1.32) after adjusting for age, gender, race and other demographical factors.

As expected, HIV and AIDS were also highly significant predictors of FN, with HRs of 3.40 and 2.84, respectively.

The risk of FN also increased with the number of comorbities, giving respective HRs of 1.29, 1.51 and 1.73 for patients with one, two or at least three illnesses versus none.

As reported in the Annals of Oncology, there was also a significant relationship between comorbidity and other neutropaenia outcomes. In particular, COPD, thyroid disorders and having three or more comorbidities were associated with the development of grade III/IV neutropaenia.

By contrast, obesity protected against the development of FN, grade III/IV neutropaenia and grade IV neutropaenia, with HRs of 0.78, 0.80 and 0.80, respectively.

“Potential mechanisms through which obesity may confer protection from chemotherapy-induced toxicity include altered Pharmacokinetics and/or reduced relative efficacy of chemotherapy in obese patients”, the researchers comment.

“Our results provide additional assurance that obese patients are not at increased risk of FN, which may have implications for chemotherapy dose adjustment for these patients.”


Chao C, Page J, Yang S-J, et al. History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in cancer patients not receiving G-CSF. Ann Oncol 2014; First published online 10 June. doi: 10.1093/annonc/mdu203

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