Hosmer et al developed a model for predicting febrile neutropenia (FN) in an older adult with a common cancer started on chemotherapy. This can help to identify a patient who may benefit from more aggressive management. The authors are from University of California Los Angeles and the Greater Los Angeles VA Medical Center.
Patient selection: adult >= 65 years of age, one of 4 common cancers, first cycle chemotherapy
Outcome: febrile neutropenia
Parameters:
(1) type of cancer
(2) Stage at diagnosis
(3) time from diagnosis to first chemotherapy treatment in months
(4) chemotherapy agents with myelosuppressive potential
(5) comorbid conditions at diagnosis
|
Parameter |
Finding |
Points |
|
type of cancer |
breast |
0 |
|
|
lung |
7 |
|
|
colon |
2 |
|
|
prostate |
-13 |
|
Stage |
I |
0 |
|
|
II |
3 |
|
|
III |
3 |
|
|
IV |
5 |
|
time from diagnosis to start of chemotherapy |
< 1 month |
0 |
|
|
1 to 3 months |
-4 |
|
|
> 3 months |
-5 |
|
number of chemotherapy agents with myelo-suppressive potential |
0 |
0 |
|
|
1 or more |
1 |
|
comorbid conditions |
0 |
0 |
|
|
1 |
1 |
|
|
2 |
3 |
|
|
3 |
6 |
where:
• Comorbid conditions max out at 3.
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: -18
• maximum score: 19
• The higher the score the greater the risk of febrile neutropenia (FN).
• A patient at increased risk for febrile neutropenia might be started on granulocyte colony stimulating factor prior to chemotherapy.
|
Total Score |
Percent FN |
|
-18 to 0 |
2% |
|
1 to 3 |
5% |
|
4 to 6 |
7% |
|
7 to 9 |
9% |
|
10 to 12 |
11% |
|
13 to 19 |
13 to 16% |
Specialty: Hematology Oncology, Infectious Diseases, Pharmacology, clinical
