Geisinger Health System Wilkes-Barre, Pennsylvania
Introduction: Febrile neutropenia is a life-threatening side effect with the mortality of 5 to 11% and can exceed up to 50% in high-risk patients. The objective is to evaluate its effect on mortality, length of stay, health care costs involved with colon cancer in comparison with lung and breast cancer due to its increasing clinical and economic burden. It also involves modifications in the chemotherapy regimen.
Methods: A retrospective study was conducted in adults >18 years using the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 with the admitting diagnosis of Febrile Neutropenia in hospitalized patients with colorectal, breast and lung cancer using the ICD 9 and ICD 10 codes. Study was focused on its effect on mortality, length of stay, co-morbidities, insurance status and health care costs involved based on the cancer type. The outcome was analyzed using multivariate logistic regression analysis and statistical analysis was done using STATA.
Results: Among 7550 colorectal cancer patients, the mean hospital length of stay (LOS) was 6.2 days which is higher than breast cancer (4.5 days) and almost like lung cancer (6.2 days). The mean total health care costs were $16,272 for colorectal cancer whereas it is $11,609 and $17,503 for breast and lung cancer respectively. The in-patient mortality rate was 4% for colorectal and is 1.6% for breast and 6.5% for lung cancer. The odds ratio of in-patient mortality for lung cancer compared to colorectal cancer is 1.10 (with the p-value of 0.020 and confidence interval of 1.01 to 1.20), breast cancer in comparison to colorectal cancer is 0.67 (with p-value of < 0.001 and confidence interval of 0.59 to 0.75) and lung cancer in comparison to breast cancer is 0.99 (with p-value 0.84 and confidence interval of 0.90 to 1.08). The charlson Co-morbidity index was >3 in 75% in colorectal cancer whereas it is >3 in 58% and 85% in breast and lung cancer population.
Discussion: Increase in mean length of stay was observed in colorectal cancer compared to breast cancer and increased health care costs for colorectal cancer was also observed despite its lower incidence than breast and lung cancer. The co-morbidity risk and in-patient mortality rate for colorectal cancer is higher than breast cancer.
