Incidence and clinical outcomes of febrile neutropenia in adult cancer patients with chemotherapy using Korean nationwide health insurance database

Background

Febrile neutropenia (FN), treatment-associated bone marrow suppression often renders cancer patients prone to life-threatening infections. The aim of this study was to evaluate episodes of FN in patients with stomach, colorectal, lung and breast cancer, and identify the incidence and the trend for admission rate, costs, and factors affecting mortality.

Methods

Using nationwide claim data from the Korean Health Insurance (NHI) database, all new admissions to the hospitals for FN were selected. Prescription data of granulocyte colony-stimulating factors and antibiotics were also collected from the NHI database. We evaluated the incidence of FN and the mortality-related clinical factors in the adult cancer patients who received cytotoxic chemotherapy from January 2004 to December 2013.

Results

Total 313,316 patients were searched as newly diagnosed adult cancer with age over 18 years. Among these, 44,412 patients were hospitalized for FN during chemotherapy. The incidence of FN is 19.8% in lung cancer, 15.5% in stomach cancer, 13.3% in breast cancer, and 9.5% in colorectal cancer, respectively. The trends of incidence are increasing for 10 years, but mean hospitalization days are decreasing. Admission rate to intensive care unit is highest in lung cancer (15.2%). Mean total cost of FN is 3,115 euro per one admission. In-hospital mortality is 19.3% in lung cancer, 15.1% in stomach cancer, 8.9% in colorectal cancer, and 5.9% in breast cancer. Age and sepsis are risk factors for in-hospital mortality for all cancer type.

Conclusions

FN is increasing but length of hospitalization is decreasing in Korea. In-hospital mortality of FN was overall 12.9% and showed decreasing trends. Factors associated with increased mortality in hospitalized patients with FN are old age and sepsis.

Clinical trial identification

Legal entity responsible for the study

National health insurance service

Funding

National health insurance service

Disclosure

All authors have declared no conflicts of interest.