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J. Cupp
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P3.11 - Poster Session/ Palliative and Supportive Care (ID 231)
- Event: WCLC 2015
- Type: Poster
- Track: Palliative and Supportive Care
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.11-006 - An Analysis of Factors Associated with in Hospital Mortality in Lung Cancer Chemotherapy Patients with Neutropenia (ID 1252)
09:30 - 09:30 | Author(s): J. Cupp
- Abstract
Background:
Febrile neutropenia is considered a severe complication of cancer chemotherapy, and one for which lung cancer is frequently associated with higher mortality rates than other solid tumors. The focus of this analysis was to identify risk factors most associated with in-hospital mortality and to describe their impact on mortality in patients with lung cancer.
Methods:
Hospitalization data from the University Health Consortium database inclusive of the years 2004-2012 from 239 US medical centers were analyzed. The study population included all adult patients with solid tumors who had neutropenia. Cancer type, presence of neutropenia, comorbidities, and further subgroups were based on ICD-9-CM codes. The primary study outcome was in-hospital mortality in lung cancer patients vs. other solid tumors. Further analysis concentrated on comparisons of the two groups with respect to number and type of comorbidities, occurrence of sepsis, pneumonia, or any infection, and ICU stay and influence of these factors on mortality. Differences between the groups were compared using chi-square test.
Results:
The analysis was based on 61,086 adult patients, including 11,111 lung cancer patients and 49,975 patients with other solid tumors. Overall 4290 (7.0%) patients died. Lung cancer was the tumor type associated with highest mortality (11.2%, compared with other solid tumors, 6.1%; p <0.0001) Lung cancer patients were older: 50% of lung cancer patients were over age 65, compared to 31.6% of patients with other solid tumors (p<0.0001). Lung cancer patients were more likely to have multiple (≥2) comorbidities than patients with other solid tumors (57.3% vs. 37.3% p<0.0001). The risk of mortality was directly related to the number of comorbidities (ranging from mortality risk of 0.9% for patients with 0 comorbidities to 35.2% for patients with 5 or more). The comorbidity-mortality relationship was observed in lung cancer patients as well as patients with other solid tumors, and the association persisted after adjusting for multiple covariates, including age. Even independent of number of comorbidities and age, lung cancer patients had higher mortality (Odds Ratio (OR)=1.38, 95%CI: 1.28-1.48). Four risk factors for mortality in addition to number of comorbidities were identified: pneumonia, sepsis, any documented infection, and ICU stay. Pneumonia occurred more commonly in the lung cancer patients (26.4% vs. 10.3%; p<0.0001). Comorbid pulmonary disease was strongly associated with development of pneumonia (OR=4.52, 95%CI: 4.30-4.74) and occurred more often in the lung cancer patients (52.1% vs. 24.0%; p<0.0001). With or without pulmonary disease as a comorbidity, lung cancer patients were more likely to have pneumonia than other solid tumor types (with – 36.0% vs. 22.8%, p<0.0001) (without – 16.1% vs. 6.4%, p<0.0001).
Conclusion:
Lung cancer patients presenting with febrile neutropenia are older, have more comorbidities, have a higher incidence of comorbid pulmonary disease, and are more likely to have pneumonia. These factors may help explain their higher mortality. In order to reduce the mortality of chemotherapy in lung cancer patients, careful pretreatment assessment and optimal supportive care during therapy are critical.
