Incidence, Risk factors and Management practice of Chemotherapy-induced Neutropenia and Neutropenic Fever Among Adult Solid Cancer Patients at University of Gondar Comprehensive and Specialized Hospital: A retrospective follow up study

Abstract

ABSTRACT Background: Neutropenia and neutropenic fever are the most common and most severe bone marrow toxicities of chemotherapy that lead to a major cause of chemotherapy dose adjustment and delays that may compromise therapeutic outcomes. A few studies have been carried out to assess the incidence, associated factors, and management practice of chemotherapy-induced neutropenia and neutropenic fever in Ethiopia. Objective: This study was conducted to assess the incidence, associated factors, and management practice of chemotherapy-induced neutropenia and neutropenic fever at the University of Gondar Comprehensive and Specialized Hospital among adult solid cancer patients Methods: A hospital-based retrospective observational cohort study was used to assess the incidence, associated factors, and management practice of chemotherapy-induced neutropenia and neutropenic fever among adult solid cancer patients who were started chemotherapy from January 2017 to February 2021 at University of Gondar Comprehensive and Specialized hospital. The data was collected from patients' medical charts using a structured data abstraction format using a systematic random sampling technique. Analysis was carried out using statistics and data (STATA) version 14.2. Logistic regression analysis was carried out to identify the combinations of risk factors most likely to have caused neutropenia and neutropenic fever. The level of significance was set at P< 0.25 for bivariable and P< 0.05 for multivariable analysis. Analysis of variance(ANOVA)and the independent two-sample test were used to determine to compare the duration of neutrophil recovery time. Result: The cumulative incidence of neutropenia was 62.3% (95% CI 57.9-67.1)and the cumulative incidence of neutropenic fever was 13%(95%CI 9.9-16.3).Poor performance status, Adjusted Odds Ratio(AOR): 3.47(1.667.26)

,advanced stage, OR :3.3 (1.52-7.12),patients taking triple treatment modality,AOR:4.74(1.39-16.08),lower baseline white blood cell count,AOR:6.27(3-13.9),elevated lactate dehydrogenase,AOR:5.15(2.42 10.94),cisplatin paclitaxel,AOR:2.89(1.053-7.95),doxorubicin-cyclophosphamide,AOR:6.08(1.7621.03),doxorubicin cyclophosphamide followed by paclitaxel regimen,AOR:3.21(1.14-9.06;),patients with greater than or equal to two comorbidity,AOR:5.68 (1.92-16.8) were found to be predictors for chemotherapy-induced neutropenia. Advanced age, AOR:3.51(1.19 -10.29), lower baseline white blood cell count, AOR:3.43(1.1-10.66), prolonged duration of neutropenia, AOR: 2.52(1.19-5.33), patients with greater than or equal to two comorbidities, AOR:2.97(1.17-7.49) were found to be factors for chemotherapy-induced- neutropenic fever. Guideline line non-adherence for primary prophylaxis of neutropenic fever was 67.5%. The addition of filgrastim to both neutropenia and neutropenic fever shortens the duration of neutrophil recovery time. Based on the one-way Analysis of Variance (ANOVA) filgrastim and ciprofloxacin plus filgrastim were significantly reduced the duration of neutropenia recovery time by 33.28 days (P=0.0001) and 32.72 days (P=0.0001) respectively as compared to chemotherapy delay. Independent two-sample t-test showed that the addition of filgrastim to antibiotics significantly reduces neutropenic fever recovery days by 18.6 days (95% CI 9.912.2;

P=0.0001) compared to antibiotic treatment only. Antivirals and antifungals were commonly added inappropriately in the management of neutropenic fever. Conclusion: The Incidence of neutropenic events was common in solid cancer. Our study assessed that chemotherapy-induced neutropenia and neutropenic fever were multifactorial. The finding collectively indicates that knowledge of risk factors can assist health care providers in the prevention of chemotherapy-induced neutropenia and neutropenic fever. Filgrastim was the main management for chemotherapy-induced of neutropenia. The addition of filgrastim in neutropenic events reduced the duration of neutrophil recovery. Neutropenic fever was mainly managed by empheric antibiotics and was inappropriate. Keywords:Incidence,Neutropenia,Neutropenicfever,Solidcancer,Treatment,UniversityofGondar,Ethiopia