Development and validation of a prediction model for the risk of developing febrile neutropenia in the first cycle of chemotherapy among elderly patients with breast, lung, colorectal, and prostate cancer

Purpose Current guidelines recommend prophylactic use of granulocyte-colony stimulating factors (G-CSF) when febrile neutropenia (FN) risk is greater than 20%. Advanced age is a risk factor for FN; however, little is known about the impact of other factors on the incidence of FN in an older population. Patients and methods We analyzed SEER-Medicare data (1994–2005) to develop and validate a prediction model for hospitalization with fever, infection, or neutropenia occurring after chemotherapy initiation for patients with breast, colorectal, prostate, and lung cancer. Results In multivariate analysis ( N = 58,053) independent predictors of FN included advanced stage at diagnosis [stage 2 (OR 1.29; 95% CI: 1.09–1.53), stage 3 (1.38; 95% CI: 1.19–1.60), and stage 4 (1.57; 95% CI: 1.35–1.83)], number of associated comorbid conditions [one condition (1.13; 95% CI: 1.02–1.28), two conditions (1.39; 95% CI: 1.22–1.57), and three or more conditions (1.81; 95% CI: 1.61–2.04)], receipt of myelosuppressive chemotherapy (1.11; 95% CI: 0.94–1.32), and receipt of chemotherapy within 1 month of diagnosis [1 to 3 months (0.70; 95% CI: 0.62–0.80) and greater than 3 months (0.63; 95% CI: 0.55–0.73)]. Conclusion We created a prediction model for febrile neutropenia with first cycle of chemotherapy in a large population of elderly patients with common malignancies.