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Rifkin RM, Crawford J, Mahtani RL, Dale DC, Narang M, MacLaughlin WW, Huynh C, Gawade PL, Lewis S, DeCosta L, Lawrence T, Belani R. A prospective study to evaluate febrile neutropenia incidence in patients receiving pegfilgrastim on-body injector vs other choices. Support Care Cancer 2022; 30:7913-7922. [PMID: 35732748 PMCID: PMC9216302 DOI: 10.1007/s00520-022-07226-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
Purpose We evaluated the incidence of febrile neutropenia (FN) and related clinical outcomes among patients treated with myelosuppressive chemotherapy for nonmyeloid malignancies who received pegfilgrastim on-body injector (OBI) or other options (Other) for FN prophylaxis. Methods In this prospective observational study, adult patients with breast, prostate, or lung cancer, or non-Hodgkin lymphoma at risk for FN were stratified into subgroups based on FN prophylaxis used in the first chemotherapy cycle: pegfilgrastim OBI vs Other (pegfilgrastim or biosimilar pegfilgrastim prefilled syringe, daily filgrastim, or no granulocyte colony–stimulating factor [G-CSF]) for up to 4 planned chemotherapy cycles. Results This US study enrolled 2575 eligible patients (OBI, 1624; Other, 951). FN incidence was lower in the OBI group (6.4% [95% CI, 5.2–7.6%]) than in the Other group (9.4% [7.5–11.2%]), with a relative risk (RR) of 0.66 (0.47–0.91; p = .006). A decreased risk of dose delays among patients receiving pegfilgrastim OBI vs Other was observed (RR for ≥ 5 days: 0.64 [0.42–0.96], p = .023; RR for ≥ 7 days: 0.62 [0.40–0.91], p = .016). Adherence, defined as G-CSF support for all chemotherapy cycles, was 94.0% (92.9–95.2%) in the OBI group compared with 58.4% (55.2–61.5%) in the Other group. Compliance with pegfilgrastim, defined as administration the day after chemotherapy, was 88.3% in the OBI group and 48.8% in the prefilled syringe group. Conclusion Patients receiving pegfilgrastim OBI had a lower incidence of FN compared with those receiving alternatives. The OBI was associated with improved adherence to and compliance with clinically recommended G-CSF prophylaxis. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07226-9.
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Affiliation(s)
- Robert M Rifkin
- US Oncology Hematology Research, Rocky Mountain Cancer Centers - Midtown, 1800 Williams Street, Suite 200, Denver, CO, 80218, USA.
| | | | - Reshma L Mahtani
- Division of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Health System, Deerfield Beach, FL, USA
| | - David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Mohit Narang
- US Oncology Research, Maryland Oncology Hematology, P.A, Columbia, MD, USA
| | | | - Chanh Huynh
- Cancer Care Associates of York, York, PA, USA
| | | | | | - Lucy DeCosta
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
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Mahtani RL, Belani R, Crawford J, Dale D, DeCosta L, Gawade PL, Huynh C, Lawrence T, Lewis S, MacLaughlin WW, Narang M, Rifkin R. A prospective cohort study to evaluate the incidence of febrile neutropenia in patients receiving pegfilgrastim on-body injector versus other options for prophylaxis of febrile neutropenia: breast cancer subgroup analysis. Support Care Cancer 2022; 30:6135-6144. [PMID: 35426046 PMCID: PMC9009498 DOI: 10.1007/s00520-022-07025-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast cancer chemotherapy often carries a high risk of febrile neutropenia (FN); guidelines recommend prophylaxis with granulocyte colony-stimulating factor (G-CSF), such as pegfilgrastim. Neulasta® Onpro® on-body injector (OBI) is a delivery device administering pegfilgrastim approximately 27 h after application. METHODS This prospective study examined patients with breast cancer who received chemotherapy with a high risk of FN, receiving OBI ("OBI") or other options (other G-CSF or none; "other"). The primary endpoint was FN incidence; secondary endpoints included chemotherapy delivery, adherence (G-CSF in all cycles), compliance (G-CSF day after chemotherapy), and FN incidence in patients receiving curative or palliative treatment. RESULTS A total of 1776 patients with breast cancer were enrolled (OBI, n = 1196; other, n = 580). Across all cycles, FN incidence was lower for OBI (4.4% [95% CI, 3.3-5.6%]) than other (7.4% [5.3-9.6%]). For curative treatment, the FN incidence across all cycles was lower for OBI (4.6% [3.4-5.8%]) than for other (7.1% [5.0-9.3%]). For palliative treatment (OBI, n = 33; other, n = 20), 3 patients (15%) in the other and none in the OBI group had FN. After adjusting for baseline covariates, FN incidence remained lower for OBI (4.6% [3.5-6.1%]) versus other (7.8% [5.7-10.5%]). Adherence was higher for OBI (93.8%) than for other G-CSF (69.8%), as was compliance (90.5 and 53.2%, respectively). Chemotherapy dose delays/reductions were similar for OBI (4.7%/32.3%, respectively) and other (4.7%/30.0%) groups. CONCLUSION Pegfilgrastim OBI was associated with a lower FN incidence in patients with breast cancer compared to other options for FN prophylaxis. TRIAL REGISTRATION www. CLINICALTRIALS gov , NCT02178475, registered 30 June, 2014.
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Affiliation(s)
- Reshma L Mahtani
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
| | | | | | - David Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Chanh Huynh
- Cancer Care Associates of York, York, PA, USA
| | | | | | | | | | - Robert Rifkin
- Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO, USA
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Mahtani R, Crawford J, Flannery SM, Lawrence T, Schenfeld J, Gawade PL. Prophylactic pegfilgrastim to prevent febrile neutropenia among patients receiving biweekly (Q2W) chemotherapy regimens: a systematic review of efficacy, effectiveness and safety. BMC Cancer 2021; 21:621. [PMID: 34044798 PMCID: PMC8157684 DOI: 10.1186/s12885-021-08258-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background Pegfilgrastim, a long-acting granulocyte colony-stimulating factor (G-CSF), is commonly used to prevent febrile neutropenia (FN), a potentially life-threatening complication, following myelosuppressive chemotherapy. The FDA label for pegfilgrastim specifies that it should not be administered 14 days before or within 24 h of administration of myelosuppressive chemotherapy, precluding the use of pegfilgrastim in biweekly (Q2W) regimens. The National Comprehensive Cancer Network and the European Organisation for Research and Treatment of Cancer guidelines support the use of prophylactic pegfilgrastim in patients receiving Q2W regimens. The objective of this study was to systematically review evidence from randomized clinical trials (RCTs) and observational studies that describe the effectiveness and safety of prophylactic pegfilgrastim in preventing FN among patients receiving Q2W regimens. Methods An Ovid MEDLINE, Embase, and Cochrane Library literature search was conducted to evaluate the evidence regarding efficacy, effectiveness, and safety of prophylactic pegfilgrastim versus no prophylactic pegfilgrastim or prophylaxis with other G-CSF in patients who were receiving Q2W chemotherapy regimens with high (> 20%) or intermediate (10–20%) risk of FN for a non-myeloid malignancy. Studies that addressed absolute or relative risk of FN, grade 1–4 neutropenia, all-cause or any hospitalization, dose delays or dose reductions, adverse events, or mortality were included. Studies where the comparator was a Q3W chemotherapy regimen with primary prophylactic pegfilgrastim were also included. Results The initial literature search identified 2258 publications. Thirteen publications met the eligibility criteria, including eight retrospective, one prospective, one phase 1 dose escalation study, and three RCTs. In nine of the 13 studies reporting incidence of FN, and in seven of the nine studies reporting incidence of neutropenia, administration of prophylactic pegfilgrastim in patients receiving Q2W regimens resulted in decreased or comparable rates of FN or neutropenia compared with patients receiving filgrastim, no G-CSF, lipefilgrastim or pegfilgrastim in Q3W regimens. In six of the nine studies reporting safety data, lower or comparable safety profiles were observed between pegfilgrastim and comparators. Conclusions In a variety of non-myeloid malignancies, administration of prophylactic pegfilgrastim was efficacious in reducing the risk of FN in patients receiving high- or intermediate-risk Q2W regimens, with an acceptable safety profile. Trial registration PROSPERO registration no: CRD42019155572. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08258-w.
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Affiliation(s)
- Reshma Mahtani
- Sylvester Cancer Center, University of Miami, Deerfield Beach, FL, USA.
| | | | | | | | | | - Prasad L Gawade
- Center for Observational Research, Amgen, Thousand Oaks, CA, USA
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Mahtani RL, Crawford J, Rifkin R, Dale D, Brookhart A, Gawade PL, Lewis S, Lawrence T, Belani R, Lyman GH. Abstract PS9-50: A multicenter, prospective, observational study to determine the incidence of febrile neutropenia (FN), persistence and G-CSF utilization among cancer patients at high risk for FN receiving pegfilgrastim by an on-body injector (OBI) versus other FN prophylaxis strategies: An interim analysis. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps9-50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Pegfilgrastim is a long-acting granulocyte colony-stimulating factor (G-CSF) shown to effectively reduce the risk of chemotherapy-induced FN. Pegfilgrastim should be administered on the day after chemotherapy completion (Lyman, Cancer, 2017). For patient convenience, an OBI was developed to deliver pegfilgrastim 27 hours after OBI application on the day of chemotherapy. Real-world data on whether OBI improves patient persistence, compliance, and outcomes are limited. To address this, a multicenter, prospective, observational study was conducted to describe the incidence of FN, persistence, and G-CSF utilization among patients treated with myelosuppressive chemotherapy for non-myeloid malignancies who received pegfilgrastim by OBI or other physician choice options for FN prophylaxis. Here, we report the interim results of the study. Methods Adult patients with breast, prostate, lung cancer, or non-Hodgkin’s lymphoma were stratified into 2 groups, curative or palliative intent, and classified into subgroups of FN prophylaxis based on the first chemotherapy cycle: receiving pegfilgrastim OBI (OBI group) vs other options (Other group; options: pegfilgrastim or biosimilar pegfilgrastim prefilled syringe [PFS], daily filgrastim, no G-CSF) up to 4 planned chemotherapy cycles. Additional eligibility criteria included a life expectancy of >6 months, chemotherapy with high (>20%) FN risk or intermediate (10%-20%) FN risk with ≥1 risk factor administered once every 3 or 4 weeks, and no radiation <2 weeks before enrollment. The prespecified analysis was based on the first 2,000 enrolled patients who completed up to 4 chemotherapy cycles. The primary endpoint is the incidence of FN (defined as absolute neutrophil count [ANC] <1,000 × 106/L and one of the following occurring within 24 hours of decreased ANC: temperature >38°C, use of intravenous antibiotics, or use of oral antibiotics). The clinical study team was blinded to FN per group at the time of analysis. Secondary endpoints include persistence (defined as G-CSF support for all chemotherapy cycles regardless of the timing of administration). G-CSF utilization was included as an exploratory endpoint. Results For the analysis, 1,930 patients were eligible (OBI, 1208; Other, 722). Patients were characterized in table 1 regarding sex, age, tumor type, and FN risk of chemotherapy regimens administered. Most patients were female (OBI, 82.0%; Other, 71.7%). The most common tumor type was breast (OBI, 72.4%; Other, 57.5%). The proportion of patients undergoing chemotherapy regimens with high FN risk was higher in the OBI group than in the Other group. The overall incidence of FN was 7.3% (95% confidence interval [CI], 6.1%-8.4%). In the Other group, 60.5% of patients received pegfilgrastim PFS, 7.6% received a short-acting G-CSF, and 30.6% did not receive G-CSF support in the first cycle. Persistence to G-CSF support was 93.5% (95% CI, 92.2%-94.9%) for the OBI group and 56.9% (53.3%-60.5%) for the Other group. Updated data will be presented at the meeting. Conclusions The OBI improved adherence to clinically appropriate G-CSF support across all chemotherapy cycles. However, approximately a third of patients did not receive primary prophylaxis with G-CSF despite being considered as a high risk for FN.
CharacteristicOn-Body Injector (N=1,208)Other Physician Choice Options (N=722)Sex, n (%)Male218 (18.0)204 (28.3)Female990 (82.0)518 (71.7)Age<65 years, n (%)679 (56.2)397 (55.0)Median, years63.062.0Tumor type,a n (%)Breast874 (72.4)415 (57.5)Non-Hodgkin’s lymphoma178 (14.7)142 (19.7)Lung107 (8.9)104 (14.4)Prostate49 (4.1)51 (7.1)FN risk of chemotherapy, n (%)High777 (64.3)330 (45.7)Intermediate376 (31.1)326 (45.2)Unknown55 (4.6)66 (9.1)aTen patients were missing a tumor type in the Other Physician Choice Options group. FN, febrile neutropenia
Citation Format: Reshma L. Mahtani, Jeffrey Crawford, Robert Rifkin, David Dale, Alan Brookhart, Prasad L. Gawade, Sandra Lewis, Tatiana Lawrence, Rajesh Belani, Gary H. Lyman. A multicenter, prospective, observational study to determine the incidence of febrile neutropenia (FN), persistence and G-CSF utilization among cancer patients at high risk for FN receiving pegfilgrastim by an on-body injector (OBI) versus other FN prophylaxis strategies: An interim analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-50.
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Affiliation(s)
- Reshma L. Mahtani
- 1Division of Hematology/Oncology Sylvester Comprehensive Cancer Center, University of Miami Health System, Deerfield Beach, FL
| | | | - Robert Rifkin
- 3Research Rocky Mountain Cancer Centers – Midtown, Denver, CO
| | - David Dale
- 4Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | | | | | - Gary H. Lyman
- 7Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA
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Li S, Peng Y, Liu J, Li S, Raskin L, Kelsh MA, Zaha R, Gawade PL, Henry D, Lyman GH. Variations in hospitalization and emergency department/observation stays using the oncology care model methodology in Medicare data. Curr Med Res Opin 2020; 36:1519-1527. [PMID: 32715807 DOI: 10.1080/03007995.2020.1801403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess variations in hospitalizations, emergency department/observational (ED/OB) stays not resulting in hospitalization, reasons for hospitalization, and hospitalization discharge destinations after chemotherapy, information not provided as part of Oncology Care Model (OCM) baseline data. METHODS OCM methodology was applied to the Medicare 20% sample data to identify 6-month patient episodes triggered by chemotherapy in 2012-2015. Proportions of episodes with hospitalization or ED/OB stays, reasons for hospitalization, and discharge destinations were summarized. RESULTS Of 485,186 6-month episodes for 255,229 patients in 13,823 practices, 25% of episodes led to ≥1 hospitalization (from 14% in breast cancer to 56% in acute leukemia), and 23% to ED/OB stays (from 18% in breast cancer to 36% in liver cancer). In 2995 practices with ≥20 total episodes, practice-level proportions of episodes with hospitalization ranged from 14% to 31% (20th-80th percentile) and with ED/OB stays from 17% to 29%. For all cancers combined, the most frequent reasons for hospitalization were infection (13%), anemia (7%), dehydration (5%), and congestive heart failure (3%); the most common discharge destinations were home (71%) followed by a skilled nursing facility (13%), death (6%), and hospice (5%). Reasons for hospitalization and discharge destinations varied by cancer type; acute leukemia episodes led to the highest rates of infection and anemia, and central nervous system tumor episodes to the highest proportions of death or hospice discharge. CONCLUSION The variations in frequency of and reasons for hospitalization, ED/OB stays, and hospitalization discharge destinations across cancer types should be considered when evaluating OCM practice performance.
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Affiliation(s)
- Shuling Li
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Yi Peng
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Jiannong Liu
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Suying Li
- Chronic Disease Research Group (CDRG), Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Leon Raskin
- Center for Observation Research, Amgen Inc, Thousand Oaks, CA, USA
| | - Michael A Kelsh
- Center for Observation Research, Amgen Inc, Thousand Oaks, CA, USA
| | - Rebecca Zaha
- Center for Observation Research, Amgen Inc, Thousand Oaks, CA, USA
| | - Prasad L Gawade
- Center for Observation Research, Amgen Inc, Thousand Oaks, CA, USA
| | - David Henry
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Li S, Liu J, Gong T, Guo H, Gawade PL, Kelsh MA, Bradbury BD, Belani R, Lyman GH. Duration of short-acting granulocyte colony-stimulating factor for primary prophylaxis and risk of neutropenia-related hospitalization in older patients with cancer. J Geriatr Oncol 2020; 11:1309-1315. [PMID: 32624415 DOI: 10.1016/j.jgo.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/12/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Evaluate the relationship between duration of primary prophylactic short-acting granulocyte colony-stimulating factor (PP-sG-CSF) and risk of neutropenia-related hospitalization (NRH) in older patients receiving myelosuppressive chemotherapy. METHODS Using the Medicare claims database, we conducted a nested case-control study in a cohort of patients aged ≥66 years with breast, colorectal, lung, ovarian, or prostate cancer, or non-Hodgkin lymphoma who initiated a first cycle of any myelosuppressive chemotherapy January 1, 2008-September 30, 2016, and received PP-sG-CSF. We matched up to four controls to each NRH case by age, cancer type, regimen febrile neutropenia (FN) risk category, and year using incidence density sampling. We used conditional logistic regression adjusted for race, sex, and modified Charlson comorbidity index (CCI) to estimate relative risk of NRH related to duration of PP-sG-CSF categorized as <5 and ≥ 5 days. RESULTS Of 2148 patients receiving PP-sG-CSF, 108 (5%) experienced NRH in the first cycle. We matched 333 controls to 96 cases. Cases were similar to controls in mean age, tumor type, and intermediate/high-risk regimen, but were more likely to have CCI ≥5 and less likely to use PP-sG-CSF ≥5 days (31% vs. 39%). Adjusted ORs (95% CI) for NRH were 0.69 (0.40-1.19) for ≥5 vs. <5 days of PP-sG-CSF among patients receiving any myelosuppressive chemotherapy, 0.43 (0.21-0.89) for intermediate/high-risk regimen, and 0.42 (0.19-0.89) for any myelosuppressive chemotherapy with all agents given on cycle day one only. CONCLUSIONS Among older patients with cancer who are receiving PP-sG-CSF, ≥5 days of use was associated with substantial reduction in NRH risk.
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Affiliation(s)
- Shuling Li
- Chronic Diseases Research Group, Hennepin Healthcare Research Institute, 701 Park Ave, Suite S2.100, Minneapolis, MN 55415, USA.
| | - Jiannong Liu
- Chronic Diseases Research Group, Hennepin Healthcare Research Institute, 701 Park Ave, Suite S2.100, Minneapolis, MN 55415, USA
| | - Tingting Gong
- Chronic Diseases Research Group, Hennepin Healthcare Research Institute, 701 Park Ave, Suite S2.100, Minneapolis, MN 55415, USA
| | - Haifeng Guo
- Chronic Diseases Research Group, Hennepin Healthcare Research Institute, 701 Park Ave, Suite S2.100, Minneapolis, MN 55415, USA
| | - Prasad L Gawade
- Center for Observational Research, Amgen Inc, 1 Amgen Center Dr, Thousand Oaks, CA 91320, USA
| | - Michael A Kelsh
- Center for Observational Research, Amgen Inc, 1 Amgen Center Dr, Thousand Oaks, CA 91320, USA
| | - Brian D Bradbury
- Center for Observational Research, Amgen Inc, 1 Amgen Center Dr, Thousand Oaks, CA 91320, USA
| | - Rajesh Belani
- US Medical, Amgen Inc, 1 Amgen Center Dr, Thousand Oaks, CA 91320, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, M3-B232, Seattle, WA 98109, USA
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Schenfeld JR, Bennett CW, Li S, DeCosta LJ, Jaramillo RR, Gawade PL. Trends in use of primary prophylactic colony stimulating factors and neutropenia-related hospitalization in commercially insured patients receiving myelosuppressive chemotherapy in the United States: 2005-2017. J Oncol Pharm Pract 2020; 27:128-142. [PMID: 32326872 DOI: 10.1177/1078155220915772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Describe temporal changes in use of myelosuppressive chemotherapy, primary prophylactic colony-stimulating factor, and neutropenia-related hospitalization, in commercially insured patients. METHODS Using a large commercial administrative database, we identified annual cohorts of adult patients diagnosed with breast or lung cancer, or non-Hodgkin lymphoma and initiating myelosuppressive chemotherapy during 2005-2017. We described yearly changes in proportions of myelosuppressive chemotherapy by febrile neutropenia risk category (high, intermediate, unclassified) and proportion of prophylactic colony-stimulating factor use and unadjusted incidence of neutropenia-related hospitalization in the first cycle of myelosuppressive chemotherapy. RESULTS Annual cohorts included 4383-5888 eligible patients during 2005-2017. The proportion of eligible patients aged ≥ 65 years increased from 26.0% in 2005 to 58.2% in 2017. Myelosuppressive chemotherapy use with regimens with high risk for febrile neutropenia increased from 15.1% in 2005 to 31.0% in 2017; and regimens with intermediate risk for febrile neutropenia decreased from 63.7% to 48.1% in 2017. Prophylactic colony-stimulating factor use increased from 41.6% in 2005 to 54.3% in 2017. Crude incidence of neutropenia-related hospitalization for all cancers increased from 2.0% to 3.1%, with a substantial increase in neutropenia-related hospitalization observed among non-Hodgkin lymphoma patients (2.8% to 8.5%) during 2005-2017. CONCLUSION Among adult patients with breast and lung cancer, and non-Hodgkin lymphoma receiving myelosuppressive chemotherapy, use of regimens with high risk for febrile neutropenia increased, as did the use of prophylactic colony-stimulating factors after 2005. Incidence of neutropenia-related hospitalization increased slightly, particularly among non-Hodgkin lymphoma patients. Further studies are required to understand this increasing trend of neutropenia-related hospitalization, changing patient-level risk factors, and febrile neutropenia management.
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Affiliation(s)
- Jennifer R Schenfeld
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | - Corina W Bennett
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | - Shuling Li
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Lucy J DeCosta
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | | | - Prasad L Gawade
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
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Hawkins A, Murphy A, McNamara M, Gawade PL, Belani R, Kelsh MA. A Survey of Oncologists' Perceptions and Opinions Regarding the Use of Granulocyte Colony-Stimulating Factors. J Cancer Educ 2020; 35:178-186. [PMID: 31656028 PMCID: PMC6971139 DOI: 10.1007/s13187-019-01638-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of the study is to describe oncologists' perceptions and opinions about patient eligibility, guidelines, and barriers for use of granulocyte colony-stimulating factor (G-CSF), overall and stratified by their affiliation with the Oncology Care Model (OCM). In May 2018, we invited and recruited practicing US oncologists from a national database for an online survey. Level of agreement was identified using a seven-point scale, ranging from strongly disagree to strongly agree. Of 200 participating oncologists, 70 were OCM-affiliated. Overall, 65% of oncologists agreed or strongly agreed that all patients at high risk of febrile neutropenia (FN) should receive prophylactic G-CSF, and half agreed or strongly agreed that benefits of G-CSF outweigh the potential adverse effects. The most common barriers to G-CSF use for patients at high risk of FN included patient refusal (37.1% of OCM-affiliated oncologists vs. 21.5% of non-OCM-affiliated oncologists), not on protocol/not supported by guidelines (32.9% vs. 23.1%), lack of reimbursement to practice (30.0% vs. 15.4%), and concerns about insurance coverage (22.9% vs. 26.9%). More OCM-affiliated oncologists reported that their practices offer and strongly encourage adherence to a specific protocol for G-CSF use (49.2%) versus non-OCM oncologists (31.3%). Despite recommendations from national guidelines and strong evidence from randomized, controlled clinical trials, only two thirds of oncologists agree or strongly agree that all patients at high risk of FN should receive primary G-CSF prophylaxis. Decisions about G-CSF prophylaxis may be affected by factors other than risk of FN, such as patient choice, practice protocols/guidelines, lack of reimbursement, and insurance coverage.
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Gawade PL, Li S, Henry D, Smith N, Belani R, Kelsh MA, Bradbury BD. Patterns of granulocyte colony-stimulating factor prophylaxis in patients with cancer receiving myelosuppressive chemotherapy. Support Care Cancer 2020; 28:4413-4424. [PMID: 31919669 PMCID: PMC7378111 DOI: 10.1007/s00520-020-05295-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Purpose To evaluate patterns of primary prophylactic (PP) granulocyte colony–stimulating factor (G-CSF) use following chemotherapy by cancer type and febrile neutropenia (FN) risk. Methods Using a commercial administrative database, we identified adult patients diagnosed with breast, colorectal, lung, ovarian cancer, or non-Hodgkin lymphoma (NHL) who initiated chemotherapy with high risk (HR) or intermediate risk (IR) for FN between January 1, 2013, and August 31, 2017. We describe use of PP-G-CSF, proportion completing all their cycles with pegfilgrastim, timing of pegfilgrastim, and duration of short-acting G-CSF. Results Among 22,868 patients (breast 11,513; colorectal 3765; lung 4273; ovarian 1287; and NHL 2030), 36.8% received HR and 63.2% received IR (64.4% of whom had ≥ 1 risk factor [RF] for FN). Proportions of patients receiving PP-G-CSF in the first cycle were 76.1%, 28.2%, and 26.4% among patients receiving HR, IR, and IR plus ≥ 1 RF, respectively. Among breast cancer patients receiving HR regimens and initiating PP-pegfilgrastim, 60.4% (95% confidence interval [CI] 57.2–63.6%) initiating via on-body injector (OBI) and 51.9% (95% CI 48.0–55.8%) initiating via prefilled syringe (PFS) completed all their cycles with OBI and PFS, respectively. Among all cycles with PP-PFS, 8.5% received PFS on the same day as chemotherapy completion. Mean administrations/cycle were 3.2 (standard deviation [SD] 2.3) for filgrastim, 3.0 (SD 1.6) for filgrastim-sndz, and 4.3 (SD 2.5) for tbo-filgrastim. Conclusions There is under- and mistimed use of PP-G-CSF among patients at HR for FN. Novel pegfilgrastim delivery devices could help breast cancer patients at HR for FN complete all their cycles with timely prophylaxis. Electronic supplementary material The online version of this article (10.1007/s00520-020-05295-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prasad L Gawade
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
| | - Shuling Li
- Chronic Diseases Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - David Henry
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Rajesh Belani
- US Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA
| | - Michael A Kelsh
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Brian D Bradbury
- Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
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Li S, Liu J, Gong T, Guo H, Gawade PL, Kelsh MA, Bradbury BD, Belani R, Lyman GH. Risk of neutropenia-related hospitalization (NRH) related to duration of short-acting granulocyte colony stimulating factor (sG-CSF) for primary prophylaxis. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18181 Background: In clinical trials, efficacy of 1011 days of primary prophylactic (PP) sG-CSF is similar to a single dose of pegfilgrastim for preventing febrile neutropenia (FN). However, most patients receive < 10 days of PP sG-CSF in clinical practice. This study assessed the effect of PP sG-CSF duration on the risk of NRH. Methods: Using Medicare 20% sample data, we conducted a nested case-control study within a cohort of patients aged ≥66 y with breast, colorectal, lung, ovarian, or prostate cancer or NHL who initiated first cycle of chemotherapy 1/1/20089/30/2016, had ≥1 y continuous coverage in Medicare parts A and B before cycle day 1 (baseline), and received PP sG-CSF. We identified NRH cases (ICD-9, 288.0X; ICD-10, D70.X) from cycle day 5 to end of cycle 1. We matched each case to up to 4 controls based on age (± 1 y), tumor type, regimen risk for FN (intermediate/high [ > 10%], other), and year using incidence density sampling. Duration of sG-CSF (days of use from cycle day 1 to the day before case date) was categorized as < 5 and ≥5 days. We used conditional logistic regression adjusted for race, sex, and Charlson comorbidity index (CCI) at baseline to estimate relative risk of NRH related to duration of sG-CSF. Results: Of 1431 patients receiving PP sG-CSF, 68 cases matched 231 controls. Cases were similar to controls in age (76 vs 75 y), tumor type (NHL, 62% vs 62%; lung cancer, 25% vs 25%), intermediate-/high-risk regimen (65% vs 67%), and male sex (50% vs 48%) but had slightly higher CCI (3.9 vs 3.3). The percentage of patients with ≥5 days of PP sG-CSF use was 26% in cases and 41% in controls. The adjusted OR (95% CI) for NRH was 0.48 (0.250.93) for ≥5 vs < 5 days of PP sG-CSF; results were consistent across sensitivity analyses (Table). Conclusions: Among elderly cancer patients receiving PP sG-CSF, ≥5 days of sG-CSF use was associated with substantial reduction in the risk of NRH.[Table: see text]
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Affiliation(s)
- Shuling Li
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
| | - Jiannong Liu
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
| | - Tingting Gong
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
| | - Haifeng Guo
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
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Weycker D, Hanau A, Lonshteyn A, Kim C, Gawade PL, Bowers C. Use of myelosuppressive chemotherapy and colony-stimulating factor (CSF) prophylaxis: A longitudinal assessment of practices participating in the Centers for Medicare and Medicaid Services (CMS) oncology care model (OCM). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12 Background: The CMS OCM is a 5-year program (7/2016 – 6/2021) focused on improving oncology care by incentivizing practices via financial and performance accountability. Little is known about practices participating in the OCM and whether patterns of care have changed over time. Methods: We used a retrospective cohort with structured elements from national electronic health record dataset provided by Flatiron Health (1/2012-12/2017). Data were de-identified to prevent patient and provider re-identification. Study population included adults with breast, colorectal, lung, or ovarian cancer or non-Hodgkin lymphoma who received chemotherapy with intermediate/high-risk for febrile neutropenia (FN). Patient characteristics, treatment, and supportive care within OCM and non-OCM practices were evaluated overall and by calendar year. Results: Study population included 42,699 patients at 53 OCM practices, and 25,613 patients at 149 non-OCM practices. OCM practices were larger (mean: 806 vs. 172 patients); age (mean: 62 vs. 62 years), cancer type (breast cancer: 53% vs. 52%), chemotherapy (high FN-risk: 49% vs. 48%), and other characteristics were comparable between patients in OCM and non-OCM practices. Use of high (vs. intermediate) FN-risk chemotherapy in 2012, 2015, and 2017 was 48%, 50%, and 48% in OCM practices and 50%, 50%, and 48% in non-OCM practices. CSF prophylaxis use, while higher in OCM practices, decreased over time in both subgroups (OCM: 70% in 2012 to 65% in 2017; non-OCM: 63% in 2012 to 58% in 2017). Use of pegfilgrastim (vs. short-acting CSFs) was > 94% across years in OCM and non-OCM practices. Use of the on-body injector (vs. prefilled syringe) increased from 26% of pegfilgrastim use in 2015 to 73% in 2017 in OCM practices and from 16% to 63% in non-OCM practices. Conclusions: Although OCM practices are larger and more commonly use CSF prophylaxis than non-OCM practices, trends in use of high FN-risk chemotherapy and declining prophylactic support appear to be similar between subgroups. Additional research is needed to evaluate whether such changes impacted health outcomes.
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12
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Li S, Peng Y, Li S, Raskin L, Kelsh MA, Zaha R, Gawade PL, Henry D. Variations in hospitalization and emergency department or observation (ED/OB) stays using the oncology care model (OCM) methodology in Medicare data. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.30_suppl.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
112 Background: The Medicare OCM started in 2016 to improve oncology care and reduce costs. Two metrics for care evaluation are hospitalizations and ED/OB stays. Baseline data (2012−2015) on variations in all-cause hospitalization and ED/OB stays not resulting in hospitalization in the 21 reconciliation-eligible cancer types are not well characterized. Methods: We applied OCM methodology in Medicare fee-for-service 20% sample data to estimate 6-month patient (pt) episodes triggered by chemotherapy, as well as associated cancer type and practice, from 2012 to 2015. Proportions of episodes with hospitalization and ED/OBs stay were summarized overall and by cancer for all episodes and by practice in those with ≥20 pt-episodes. Results: In total, 485,186 pt-episodes at 13,823 practices were identified (mean episodes/practice, 35.1; median, 2; IQR, 1–15). The mean number of episodes/pt was 1.90 overall (from 1.17 in anal cancer to 2.32 in multiple myeloma [MM]). The proportion of episodes with hospitalization was 25% overall (from 14% in breast cancer [BC] to 56% in acute leukemia) and with ED/OB stays was 23% overall (from 18% in BC to 36% in liver cancer). In 2,995 practices with ≥20 total episodes, at practice-level, the proportion of episodes with hospitalization ranged (20th–80th percentile) from 14% to 31% and with ED/OB stays from 17% to 29%. For select cancers, the range of proportion of episodes with hospitalization and ED/OB stays were highest for lung cancer (LC) and lowest for BC (Table). Conclusions: The proportion of 6-month OCM episodes of care with hospitalization and ED/OB stays after chemotherapy varied by cancer and was higher for certain solid and hematological malignancies. Variations between practices and cancers are important factors when evaluating OCM performance. [Table: see text]
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Affiliation(s)
- Shuling Li
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
| | - Yi Peng
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
| | - Suying Li
- The Chronic Disease Research Group (CDRG), Minneapolis, MN
| | | | | | | | | | - David Henry
- University of Pennsylvania, Philadelphia, PA
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Gawade PL, Berlin JA, Henry DH, Tomita D, Brooks BD, Franklin J, Bradbury BD, Critchlow CW. Changes in the use of erythropoiesis-stimulating agents (ESAs) and red blood cell transfusion in patients with cancer amidst regulatory and reimbursement changes. Pharmacoepidemiol Drug Saf 2017; 26:1357-1366. [DOI: 10.1002/pds.4293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 06/13/2017] [Accepted: 07/23/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Prasad L. Gawade
- Center for Observational Research; Amgen Inc.; Thousand Oaks CA USA
| | | | - David H. Henry
- Department of Medicine; University of Pennsylvania; Philadelphia PA USA
| | - Dianne Tomita
- Global Biostatistical Science; Amgen Inc.; Thousand Oaks CA USA
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Abstract
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with a broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.
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Affiliation(s)
- Carmen L. Wilson
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-901-595-6462; Fax: +1-901-595-5845
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Gawade PL, Hudson MM, Kaste SC, Neglia JP, Constine LS, Robison LL, Ness KK. A systematic review of dental late effects in survivors of childhood cancer. Pediatr Blood Cancer 2014; 61:407-16. [PMID: 24424790 PMCID: PMC4281834 DOI: 10.1002/pbc.24842] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022]
Abstract
Survivors of childhood cancer are at risk for dental late effects. This systematic review summarizes associations between treatment exposures and dental late effects among survivors of childhood cancer. We included investigations with at least 20 study participants conducted for 2 or more years after completion of childhood, adolescent, or young adult cancer therapy. This review suggests both independent and additive effects of radiotherapy and chemotherapy on dental complications, and identifies vulnerable groups with specific host and treatment characteristics. This summary provides information that will assist clinicians to prevent, detect, and facilitate early intervention for dental late effects.
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Affiliation(s)
- Prasad L. Gawade
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105 ,Oncology, St. Jude Children’s Research Hospital, Memphis, TN
38105
| | - Sue C. Kaste
- Oncology, St. Jude Children’s Research Hospital, Memphis, TN
38105 ,Radiological Sciences at St. Jude Children’s Research
Hospital, Memphis, TN 38105 ,Department of Radiology, College of Medicine, University of
Tennessee Health Science Center, 910 Madison, Suite 1002, Memphis, TN 38163
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota Medical School,
Minneapolis, MN 55455
| | - Louis S. Constine
- Departments of Radiation Oncology and Pediatrics, School of Medicine
and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 647,
Rochester, NY 14642
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude
Children’s Research Hospital, Memphis, TN 38105
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Gawade PL, Hudson MM, Kaste SC, Neglia JP, Wasilewski-Masker K, Constine LS, Robison LL, Ness KK. A systematic review of selected musculoskeletal late effects in survivors of childhood cancer. Curr Pediatr Rev 2014; 10:249-62. [PMID: 25403639 PMCID: PMC4336580 DOI: 10.2174/1573400510666141114223827] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/25/2014] [Accepted: 10/30/2014] [Indexed: 11/22/2022]
Abstract
Survivors of childhood cancer are at risk for treatment-related musculoskeletal late effects. Early detection and orthopedic intervention can help ameliorate musculoskeletal late effects and prevent subsequent complications. This systematic review summarizes the literature describing associations between cancer, its treatment, and musculoskeletal late effects. We searched PubMed and Web of Science for English language articles published between January 1970 and December 2012. The search was limited to investigations with at least 15 participants and conducted at least 2 years after completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal effects, including low bone mineral density, osteonecrosis, slipped capital femoral epiphyses, oncogenic rickets, and hormonerelated growth disturbances have been previously reviewed and were excluded, as were outcomes following amputation and limb-salvage procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An additional 54 studies that met inclusion criteria were found in reference lists of retained studies. Of 84 studies, 60 focused on associations between radiotherapy, six between chemotherapy, and 18 between surgery and musculoskeletal late effects. We found that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume influences the effects of radiation on the musculoskeletal system. Methotrexate and vincristine are associated with long-term muscular strength and flexibility deficits. Laminectomy and chest wall resection are associated with spinal malalignment, and enucleation is associated with orbital deformities among survivors. Radiotherapy, chemotherapy, and surgery are associated with musculoskeletal late effects independently and additively. Associations are additionally influenced by host and treatment characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | - Kirsten K Ness
- Department of Epidemiology and Cancer Control MSN 735, S-6013, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
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Gawade PL, Whitcomb BW, Chasan-Taber L, Pekow PS, Ronnenberg AG, Shah B, Plevyak MP, Markenson GR. Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation. J Matern Fetal Neonatal Med 2013; 26:1292-8. [DOI: 10.3109/14767058.2013.783804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gawade PL, Ness KK, Sharma S, Li Z, Srivastava DK, Spunt SL, Nottage K, Krasin MJ, Hudson MM, Kaste SC. Association of bone mineral density with incidental renal stone in long-term survivors of childhood acute lymphoblastic leukemia. J Cancer Surviv 2012; 6:388-97. [PMID: 22956305 DOI: 10.1007/s11764-012-0241-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/26/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Our objective was to evaluate the association between low bone mineral density (BMD) and incidental renal stones among long-term survivors of childhood acute lymphoblastic leukemia (ALL). METHODS Adult participants who were 10+ years from their childhood ALL diagnosis and members of the St. Jude Lifetime Cohort study were recruited between December 2007 and March 2011. During their risk-based medical evaluations, they underwent quantitative computed tomography (QCT) to evaluate BMD. Incidental renal stones were identified by radiologists' review of axial QCT source images. Demographic and dietary information were abstracted from health surveys and the Block Food Frequency questionnaire, respectively. The multivariable logistic regression model was used for analysis. RESULTS At a median of 26.1 years from diagnosis, BMD Z scores were ≤-2 in 34 of 662 (5.2 %) and renal stones detected in 73 of 662 (11 %) participants. Adjusted for age, renal radiation, dietary vitamin D, gender, and body mass index, when compared to those with BMD Z scores ≥0, the risk of renal stones was increased among those with BMD Z scores ≤-2 (odds ratio [OR], 2.92; 95 % confidence interval [CI] 1.14-7.48). Risk of renal stones significantly increased for older age (45-54 vs.18-24 years; OR, 3.70; 95 % CI 1.11-12.35) whereas the risk was higher but nonsignificant for >141.5 IU (sample median) daily intake of vitamin D (OR, 1.64; 95 % CI 0.98-2.75). CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS Older ALL survivors with BMD Z scores ≤-2 are at risk for renal stones and should be counseled so that appropriate follow-up care can be provided for those among whom renal stones are detected.
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Affiliation(s)
- Prasad L Gawade
- Department of Epidemiology and Cancer Control MSN 735, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-2794, USA.
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Murty S, Rees J, Gawade PL, Zawada ET. Propofol-Induced Metabolic Acidosis: A Retrospective Observational Study. Chest 2010. [DOI: 10.1378/chest.10200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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