scholarly journals Higher Mortality Rates in Breast and Lung Cancer Patients Admitted for Febrile Neutropenia: An Analysis of Outcomes Based on Data from the Nationwide Inpatient Sample from 2006-2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5904-5904
Author(s):  
Ankit Shah ◽  
Stuthi Perimbeti ◽  
Sumera Bukhari ◽  
Michael Wismer ◽  
Jordan Senchak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Mortality Rates ◽  
Primary Diagnosis ◽  
Lung Cancer Patients ◽  
Total Charges

Abstract Background: Febrile neutropenia is associated with significant morbidity, mortality, healthcare resource utilization and associated cost. However, data regarding the relationship of specific cancers with admission for febrile neutropenia and their outcomes is lacking. Methods: Using the ICD-9 codes 288.00 and 288.04, we identified all adult admissions with primary diagnosis of febrile neutropenia during the interval of 2006-2013 from the Nationwide Inpatient Sample (NIS). Hospitalization information regarding mortality rates, length of stay and total charges was extracted for each year. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Differences in these variables in teaching and nonteaching institutions were evaluated. ICD-9 codes for esophageal, colon, rectal, liver, pancreatic, bladder, prostate, cervical, renal, thyroid, lung, and melanoma skin cancers were selected and the percentage of admissions attributed to each malignancy was determined. Results: We identified 48,253 admissions (weighted N = 233,116) with a primary diagnosis of febrile neutropenia from 2006-2013. Most of these admissions occurred at teaching institutions (n=28,902, weighted n=139,574). In-hospital mortality rates for febrile neutropenia had a downward trend over the time period of 2006-2013 although the difference was not statistically significant (p=.082). Specifically, the in-hospital mortality rate was 2.73% in 2006 and 1.35% in 2013. Mean length of stay (days) has decreased from 5.67 (±.16) in 2006 to 5.32 (±0.06) in 2013 (p=.0001) while total charges have increased from $29,113 (±1089) in 2006 to $41,713 (±726) in 2013 (p=.0001). This is greater than the expected inflationary change from $29,133 to $33,641 over the same time period. Mean length of stay (days) was found to be higher at teaching (5.89±.03) than at non-teaching (5.25±.04) hospitals (p=.0001). Similarly, mean total charges were higher in teaching ($41,577±364) than in non-teaching ($34,176±345) institutions (p=.0001). When comparing teaching vs. non-teaching institutions, in-hospital mortality was not found to have a statistically significant difference (p=.2688). Of the 13 malignancies queried, lung cancer (11.06%) and breast cancer (8.40%) accounted for more admissions for febrile neutropenia than the other malignancies selected. Breast cancer (3.62%, p=.0001) and lung cancer (16.11%, p=.0001) were also associated with much higher in-hospital mortality rates compared with the other malignancies selected. Conclusions: Breast and lung cancer account for a significant number of admissions for febrile neutropenia, which is consistent with their national prevalence. Of particular note,breast and lung cancer patients who were admitted for febrile neutropenia had a higher risk of mortality. In lung cancer, the frequently associated smoking-related comorbidities may be contributing to this finding. While in breast cancer, patients with advanced disease have an increase in cumulative lifetime dose of chemotherapy due to prolonged survival and this may result in a weakened bone marrow, a more susceptible patient, and consequently an increase in febrile neutropenia and mortality rates. Thus, given the greater mortality rate and significant number of patients affected, patients with these two malignancies should receive special attention to ensure they receive prophylaxis with granulocyte stimulating agents and/or antibiotics after treatment with cytotoxic chemotherapy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Risk and mortality associated with febrile neutropenia in lung cancer patients

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 7223-7223
Author(s):  
D. B. Daniel ◽  
J. Crawford ◽  
N. M. Kuderer ◽  
D. C. Dale ◽  
G. H. Lyman
Keyword(s):  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Lung Cancer Patients

scholarly journals Post-Acute Care Service use in Lung Cancer Patients

2021 ◽  
Author(s):  
Mitra McLarney ◽  
Frances S. Shofer ◽  
Jasmine Zheng
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Acute Care ◽  
Service Use ◽  
Care Service ◽  
Rehabilitation Service ◽  
Lung Cancer Patients ◽  
Acute Care Service ◽  
Post Acute Care

Abstract Purpose: Lung cancer patients experience functional deconditioning secondary to their underlying cancer and treatment yet rehabilitation service use remains low. The goal of this study is to compare post-acute care service use in lung cancer patients admitted to a metropolitan academic medical center. Methods: Adult lung cancer patients admitted from January 1, 2017 to August 31, 2018 with a diagnosis of lung cancer based on International Classification of Diseases 10, C34.0-C34.9, were included in this study. Patient characteristics including age, gender, race, marital status, functional status on admission, length of stay, and number of comorbidities were compared based on discharge setting. Results: 1,139 lung cancer patients were included in our study. The majority of patients discharged home with home care (51%) followed by home without services (35%), skilled nursing facilities (SNF) (10%) and acute inpatient rehabilitation facilities (IRF) (4%). 44% (498) of patients were primarily admitted for their lung cancer diagnosis. In unadjusted analyses, patients who discharged to SNF compared to home were more likely to be older, black, unmarried, live alone and have died during the study period. Patients who discharged to IRF had longer acute care hospitalization length of stays. In adjusted analyses, age, number of concurrent comorbidities and length of stay significantly correlated with discharge location. Conclusion: Lung cancer patients are unlikely to be discharged to a post-acute care facility after an acute hospitalization. Rehabilitation service use differs by sociodemographic factors, concurrent medical history and functional status. Future study is needed to better understand why these differences in discharge setting persists.

scholarly journals Integrated sequence and gene expression analysis of mouse models of breast cancer reveals critical events with human parallels

2018 ◽  
Author(s):  
Jonathan P Rennhack ◽  
Matthew Swiatnicki ◽  
Yueqi Zhang ◽  
Caralynn Li ◽  
Evan Bylett ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Mouse Models ◽  
Copy Number ◽  
Human Breast Cancer ◽  
Human Cancer ◽  
Copy Number Alterations ◽  
Human Breast ◽  
Lung Cancer Patients

AbstractMouse models have an essential role in cancer research, yet little is known about how various models resemble human cancer at a genomic level. However, the shared genomic alterations in each model and corresponding human cancer are critical for translating findings in mice to the clinic. We have completed whole genome sequencing and transcriptome profiling of two widely used mouse models of breast cancer, MMTV-Neu and MMTV-PyMT. This genomic information was integrated with phenotypic data and CRISPR/Cas9 studies to understand the impact of key events on tumor biology. Despite the engineered initiating transgenic event in these mouse models, they contain similar copy number alterations, single nucleotide variants, and translocation events as human breast cancer. Through integrative in vitro and in vivo studies, we identified copy number alterations in key extracellular matrix proteins including Collagen 1 Type 1 alpha 1 (Col1a1) and Chondroadherin (CHAD) that drive metastasis in these mouse models. Importantly this amplification is also found in 25% of HER2+ human breast cancer and is associated with increased metastasis. In addition to copy number alterations, we observed a propensity of the tumors to modulate tyrosine kinase mediated signaling through mutation of phosphatases. Specifically, we found that 81% of MMTV-PyMT tumors have a mutation in the EGFR regulatory phosphatase, PTPRH. Mutation in PTPRH led to increased phospho-EGFR levels and decreased latency. Moreover, PTPRH mutations increased response to EGFR kinase inhibitors. Analogous PTPRH mutations are present in lung cancer patients and together this data suggests that a previously unidentified population of human lung cancer patients may respond to EGFR targeted therapy. These findings underscore the importance of understanding the complete genomic landscape of a mouse model and illustrate the utility this has in understanding human cancers.

Primary Prophylaxis of Febrile Neutropenia With Pegfilgrastim in Small-cell Lung Cancer Patients Receiving Amrubicin as Second-line Therapy

2021 ◽  
Vol 41 (3) ◽  
pp. 1615-1620
Author(s):  
YUKINA SATO ◽  
HIROTOSHI IIHARA ◽  
MOTOHIKO KINOMURA ◽  
CHIEMI HIROSE ◽  
HIRONORI FUJII ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Primary Prophylaxis ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
Second Line Therapy ◽  
Lung Cancer Patients ◽  
Line Therapy

scholarly journals P14.105 High incidence of brain metastases in lung cancer patients at the time of primary diagnosis

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii92-iii93
Author(s):  
E Kobyakova ◽  
E Nechipay ◽  
D Sashin ◽  
N Kobiakov ◽  
G L Kobyakov
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Ct Scan ◽  
Contrast Enhancement ◽  
Cancer Patients ◽  
Brain Mri ◽  
Primary Diagnosis ◽  
Lung Cancer Patients ◽  
Diagnostic Protocol ◽  
High Incidence

Abstract BACKGROUND Brain metastases (BM) affect 8%-10% of all cancer patients and 40% of patients with metastatic cancer. The majority of BM originate from lung cancer (40%-50%), breast cancer (15%-25%), and melanoma (5%-20%). Total incidence proportions percentage (IP %) of brain metastases was reported as 9.6% for all primary sites combined, and was highest for lung cancer (19.9%). The incidence of BM is believed to be increasing, likely resulting from longer patient survival due to more effective systemic therapies for the primary cancer and the increased use of neuroimaging in neurologically asymptomatic patients. MATERIAL AND METHODS Our aim was to determine incidence of brain metastases in lung cancer patients at the time of primary diagnosis on cohort of our regular clinical practice. Since September 2014 till December 2017 189 primarily diagnosed patients with suspected lung cancer were evaluated with brain MRI as obligatory part of diagnostic protocol at N.N. Blokhin Russian Cancer Research Center. MR imaging protocol included T1, T2-weighted images, FLAIR, DWI, VIBE (with contrast enhancement, slice thickness <1.2 mm). According to diagnostic guidelines for lung cancer in Russia, all patients underwent chest CT scan with contrast enhancement, bronchoscopy, abdominal ultrasonography, ultrasonography of cervical lymph nodes (+ CT to evaluate detected abnormalities), bone scintigraphy with X-ray control of detected abnormalities, surgical removal (in case of T1-T2 tumor) or tumor biopsy to determine morphology. Additionally, all patients underwent Whole Body MR DWI, some patients received FDG-PET/CT scan. RESULTS Brain metastases were detected in 89 (48%) of 189 patients, while only 9 patients (10.1% of patients with brain metastases) had neurological deficits. Lesion sizes were as follows: 0.1–0.5 cm in 46 (51.7%) patients, 0.5–1.0 cm in 21 (23.6%) patients, 1.0–2.0 cm in 7 (7.9%) patients, 2.0–3.0 cm in 8 (9.0%) patients and >3.0 in 7 (7.9% patients). The majority of patients (45 - 50.56%) had solitary metastases, 10 patients (11.24%) had two lesions and 34 (38.20 %) patients had three and more lesions. Metastatic disease most commonly affected frontal lobes - 45 (50.56%) patients, temporal lobes - 36 (40.45%) patients, parietal lobes - 22 (24.72%) patients, occipital lobes - 22 (24.72%), basal ganglia and brainstem - 18 (20.22%), - 3 (3.37%), cerebellum - 30 (33.71%) patients. Concerning morphology, in 80 of 89 brain metastases NSCLC was identified and in 9 patients SCLC was observed. CONCLUSION Very high incidence of brain metastases in lung cancer patients at the time of primary diagnosis in our study cohort may be explained by the use of precision brain MRI as an obligatory part of diagnostic protocol at the time of primary admission. We suggest including precision brain MRI in guidelines for primary diagnosis of lung cancer patients as an obligatory examination

scholarly journals Treatment Patterns Among De Novo Metastatic Cancer Patients Who Died Within 1 Month of Diagnosis

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Helmneh M Sineshaw ◽  
Ahmedin Jemal ◽  
Kimmie Ng ◽  
Raymond U Osarogiagbon ◽  
K Robin Yabroff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Cancer Patients ◽  
De Novo ◽  
Metastatic Cancer ◽  
Treatment Patterns ◽  
Cancer Type ◽  
Cancer Centers ◽  
Lung Cancer Patients ◽  
Metastatic Lung

Abstract Background Little is known about patterns of and factors associated with treatment for de novo metastatic cancer patients who die soon after diagnosis. In this study, we examine treatment patterns for patients newly diagnosed with metastatic lung, colorectal, breast, or pancreatic cancer who died within 1 month of diagnosis. Methods We identified 100 848 adult patients in the National Cancer Database with de novo metastatic lung, colorectal, breast, and pancreatic cancer, diagnosed between 2004 and 2014 and who died within 1 month. We performed descriptive and multivariable logistic regression analyses to examine receipt of surgery, chemotherapy, radiation, and hormonal therapy by cancer type, adjusting for sociodemographic and clinical variables. Results Treatment substantially varied by cancer type, over time, age, insurance, and facility type. Surgery ranged from 0.4% in pancreatic to 28.3% in colorectal cancer (CRC) patients, chemotherapy from 5.8% among CRC to 11% in lung and breast cancer patients, and radiotherapy from 1.3% in pancreatic to 18.7% in lung cancer patients. Use of some treatments (eg, surgery for CRC and breast cancer) progressively declined between 2004 and 2014. Compared with lung cancer patients treated at National Cancer Institute-designated cancer centers, those treated at community cancer centers had 48% lower odds of radiation. Conclusions Treatment of patients diagnosed with imminently fatal de novo metastatic cancer varied markedly by cancer type and patient/facility characteristics. These variations warrant more research to better identify patients with imminently fatal de novo metastatic cancer who may not benefit from aggressive and expensive therapies.

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