Ahmed Taha1, Inbal Vinograd2, Ali Sakhnini1, Noa Eliakim-Raz3, Laura Farbman3, Rina Baslo4, Salomon M Stemmer5, Anat Gafter-Gvili3, Leonard Leibovici3, Mical Paul6. 1. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 2. Pharmacy Services, Schneider Children's Medical Center, Petah Tikva, Israel. 3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 4. Department of Oncology - Hematology, Schneider Children's Medical Center, Petah Tikva, Israel. 5. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute of Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Israel. 6. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. Electronic address: paulm@post.tau.ac.il.
Abstract
OBJECTIVES: Adherence to scheduled chemotherapy is important for optimal outcomes of cancer patients. We examined causes for delay or cancellation of planned chemotherapy, focusing on mild respiratory infections during the winter. METHODS: Prospective cohort study. We included all adults with solid or hematologic cancer receiving active chemotherapy treatment during the winter of 2010-2011 in a cancer center. We compared baseline characteristics and outcomes between patients with and without chemotherapy delays, cancellations, or dose-reductions ("chemotherapy delay"). RESULTS: We included 547 patients receiving chemotherapy during the winter of 2011. Of these, 213 (38.9%) patients experienced 306 episodes of chemotherapy delays. The main documented reasons for the chemotherapy delay were neutropenia (84/306, 27.4%), fever or infection (73/306, 23.9%) and thrombocytopenia (26/306, 8.5%). Independent risk factors for chemotherapy delays were upper respiratory infections (OR 1.87, 95% CI 1.27-2.76), lymphopenia, prior hospitalization, peripheral vascular disease and colon cancer relative to hematologic cancer. In the adjusted analysis focusing on chemotherapy delays due to infection alone, upper respiratory infections (OR 5.25, 95% I 2.81-9.84) and age were significant independent risk factors. DISCUSSION: Mild respiratory infections were associated with chemotherapy delays. Our results should encourage modalities to prevent influenza and other upper respiratory infections among cancer patients.
OBJECTIVES: Adherence to scheduled chemotherapy is important for optimal outcomes of cancerpatients. We examined causes for delay or cancellation of planned chemotherapy, focusing on mild respiratory infections during the winter. METHODS: Prospective cohort study. We included all adults with solid or hematologic cancer receiving active chemotherapy treatment during the winter of 2010-2011 in a cancer center. We compared baseline characteristics and outcomes between patients with and without chemotherapy delays, cancellations, or dose-reductions ("chemotherapy delay"). RESULTS: We included 547 patients receiving chemotherapy during the winter of 2011. Of these, 213 (38.9%) patients experienced 306 episodes of chemotherapy delays. The main documented reasons for the chemotherapy delay were neutropenia (84/306, 27.4%), fever or infection (73/306, 23.9%) and thrombocytopenia (26/306, 8.5%). Independent risk factors for chemotherapy delays were upper respiratory infections (OR 1.87, 95% CI 1.27-2.76), lymphopenia, prior hospitalization, peripheral vascular disease and colon cancer relative to hematologic cancer. In the adjusted analysis focusing on chemotherapy delays due to infection alone, upper respiratory infections (OR 5.25, 95% I 2.81-9.84) and age were significant independent risk factors. DISCUSSION: Mild respiratory infections were associated with chemotherapy delays. Our results should encourage modalities to prevent influenza and other upper respiratory infections among cancerpatients.