背景:接受骨髓抑制治疗的老年癌症患者发生发热性中性粒细胞减少症(FN)或化疗剂量减少或延迟的风险增加,导致次优的健康结果。粒细胞集落刺激因子(G-CSF)是减少这些不良事件的有效药物,建议用于65岁以上接受化疗且FN风险>10%的患者。我们试图描述最年轻年龄(66-74岁)之间G-CSF使用的趋势和预测因素,中老年人(75-84岁),和年龄最大(≥85岁)的癌症患者。
方法:我们使用了SEER-Medicare的乳腺癌注册数据,肺,卵巢,结直肠,食道,胃,子宫,前列腺,胰腺癌,2010年至2019年非霍奇金淋巴瘤(NHL)诊断。使用Cox比例风险分析。
结果:总体而言,41.4%的患者从化疗开始到完成第一个化疗疗程后三天接受G-CSF。所有癌症的使用率保持相对稳定,除了胰腺癌患者的使用量增加。随着患者年龄的增长,G-CSF的使用减少。与年龄最小的人相比,年龄最大的人接受G-CSF的可能性为43.0%(95%置信区间:40.7-45.2%)。乳腺癌或NHL患者比其他癌症患者更有可能接受G-CSF。女性患者,已婚,白人或西班牙裔,合并症较少,更有可能接受G-CSF。
结论:G-CSF在发生FN和相关并发症风险较高的人群中使用频率较低。提高对建议的依从性可以改善健康结果,尤其是最年长的成年人,年长的男性,黑人患者
BACKGROUND: Older patients with cancer receiving myelosuppressive treatment are at an increased risk for developing febrile neutropenia (FN) or having chemotherapy dose-reductions or delays, resulting in suboptimal health outcomes. Granulocyte colony stimulating factors (G-CSF) are effective medications to reduce these adverse events and are recommended for patients ≥65 years receiving chemotherapy with >10 % FN risk. We sought to characterize the trends and predictors of G-CSF use between the youngest-old (66-74 years), middle-old (75-84 years), and oldest-old (≥85 years) patients with cancer.
METHODS: We used registry data from SEER-Medicare for breast, lung, ovarian, colorectal, esophageal, gastric, uterine, prostate, pancreatic cancer, and non-Hodgkin lymphoma (NHL) diagnoses from 2010 to 2019. Cox proportional hazard analysis was used.
RESULTS: Overall, 41.4 % of patients received G-CSF from chemotherapy initiation to three days after completion of the first chemotherapy course. The use rate remained relatively stable for all cancers, except for an increase in use for those with pancreatic cancer. G-CSF use decreased as patients got older. The oldest-old were 43.0 % (95 % confidence interval: 40.7-45.2 %) less likely to receive G-CSF compared to the youngest-old. Patients with breast cancer or NHL were more likely to receive G-CSF than those with other cancers. Patients who were female, married, White or Hispanic, and had fewer comorbidities were more likely to receive G-CSF.
CONCLUSIONS: G-CSF is used less often in populations at higher risk of developing FN and related complications. Improving adherence to recommendations can improve health outcomes, especially in the oldest adults, older males, and Black patients.