English abstract
Aim: Little is known about the incidence and burden of chemotherapy-induced neutropenia (CIN) in Oman or the Arabian Gulf. The aim of this study was to identify the clinical and economic characteristics of CIN at Sultan Qaboos University Hospital (SQUH) in Oman in 2010.
Methods: A retrospective observational study of the incidence, clinical and economic characteristics of CIN episodes in adult (>18) patients with oncological and hematological malignancies at SQUH from January to December 2010. Analyses were conducted using univariate statistical techniques.
Results: A total of 1,357 episodes in 159 patients were enrolled in the study. The overall mean age of the cohort was 50–15 years (range 19-91). Females constituted 54% (n=86) of the subjects. A total of 46% (73/159) of the patients developed CIN that accounted for 15% (210/1,357) of the total episodes. Only 12% (25/210) of the CIN episodes were
ated with fever in 26% (19/73) of neutropenic patients. About 45.2% of episodes had severe neutropenia. The duration of neutropenia was less than a week in most episodes (61.9%). CIN was associated with a longer hospital stay (10 days for patients hospitalized on account of CIN vs. 6 days for those hospitalized for other reasons). Out of the various CIN-related outcomes studied, chemotherapy delay was the most common neutropenic event occurring in 93% of chemotherapy delayed episodes. Dose reductions were not that frequently encountered, (12%).
The estimated CIN-related inpatient mortality was 4%. Overall, there were 406 (30%) episodes associated with the use of Granulocyte-Colony Stimulating Factors (G-CSF's). Of these, only 29% were for treatment while the majority (71%) was for prophylaxis. The majority of episodes were associated with the use of filgrastim (77%). The mean duration of treatment was approximately 4 days and the mean duration of prophylaxis was 3 days. The average cost involved in the management of patients with CIN was 80,523.2 R.O. Cost associated with hospitalization for CIN closely correlated with length of stay whereby the average cost of inpatient admission increased from 515 R.O. to 780 R.O. for CIN. There was significant association between CIN and chemotherapy regimen (p<0.001), younger age (p<0.001), low Hb level (p<0.001) and advanced cancer stage (p=0.006). The group that had neutropenia was significantly younger than the non neutropenic (45 vs. 52; p<0.001). The study did not observe any significant association between concomitant radiotherapy, recent surgery, or other co-morbidities and CIN. Those who had hypertension and diabetes mellitus were less likely to be associated with neutropenia (p=0.004 & p=0.023, respectively).
Conclusions: The study found significant incidence of CIN in SQUH patients, similar to what is observed in previous studies. CIN costs a significant amount to the healthcare and society and there were a number of significant related risk factors.
