Chemotherapy and Hospitalization

By Jane Farrell

Scientists have zeroed in on which chemotherapy regiments are likelier to lead to hospitalizations for early stage breast cancer patients.

The retrospective study, published in the Journal of Clinical Oncology, was conducted by researchers from the University of Texas MD Anderson Cancer Center. For their analysis, the researchers looked at hospitalization-related insurance claims by patients who were undergoing varying chemotherapy regimens. The reasons for hospitalization included infection, fever, anemia, dehydration, neutropenia (low white blood cell count), thrombocytopenia (low blood platelets) and delirium.

“The novelty of our study is that we were able to identify and delineate between different chemotherapy regimens in early-stage breast cancer using claims data, considered as real-world and non-clinical trial information,” said Carlos Barcenas, M.D., assistant professor, Breast Medical Oncology and corresponding author. “By characterizing subsets of patients at greatest risk for developing toxicities and adverse side-effects, clinicians may be able to select more tolerable treatments.”

For their analysis, researchers looked at statistics from the Surveillance, Epidemiology and End Results (SEER) registry, compiled by the National Cancer Institute, and the Texas Cancer Registry, identifying 3,567 patients ages 65 and older being treated for early stage breast cancer between 2003 and 2007. Additional data from Marketscan, a nation-wide employment claims database, identified 9,327 patients younger than 65 years of age with early stage disease.

Patients were then categorized into groups according to the chemotherapy regimens they received including:

Docetaxel and cyclophosphamide cycled every three weeks (TC)

Doxorubicin and cyclophosphamide cycled every three weeks (AC)

Docetaxel, doxorubicin and cyclophosphamide cycled every three weeks (TAC)

Doxorubicin and cyclophosphamide cycled every three weeks, followed or preceded by docetaxel cycled every three weeks (AC+T)

Doxorubicin and cyclophosphamide cycled every two weeks, followed or preceded by paclitaxel cycled every two weeks (ddAC+P)

Doxorubicin and cyclophosphamide cycled every three weeks followed or preceded by weekly paclitaxel (AC+wP)

Among patients younger than 65 years of age, the hospitalization rates ranged from 6.2 percent (ddAC+P) to 10 percent (TAC). In patients older than 65, rates ranged from 12.7 percent (TC) to 24.2 percent (TAC).

“Our findings demonstrate that TAC and AC+T were associated with the highest risk of hospitalization in patients younger than age 65,” Barcenas said. “And for older patients all regimens, aside from ddAC+P, were associated with a higher risk of hospitalization compared to the regimen TC.”