Cancer patients continue to be affected by FN as a result of chemotherapy: Survey

Apr 15 2010

Thirty percent of patients surveyed experienced an infection as a result of chemotherapy, 45 percent of which were associated with neutropenia or febrile neutropenia (FN) according to findings from a pan-European patient and nurse survey presented today at the 7th Annual European Oncology Nursing Society (EONS) Spring Convention. Results suggest that despite the widespread availability of prophylactic treatments, a significant number of cancer patients continue to be affected by neutropenia and its consequences.

The Preventing Febrile Neutropenia - Staying on Track with Chemotherapy survey, found that 57 percent of patients with an infection required hospitalisation, whilst 37 percent had to have their chemotherapy delayed or changed as a result of neutropenia, infection or febrile neutropenia. More than nine out of ten (95 percent) nurses questioned agreed that preventing infections, including febrile neutropenia, is extremely important to achieve a successful outcome for patients undergoing chemotherapy.

"The risk of neutropenic infections poses an additional threat to cancer patients undergoing chemotherapy, at a time when a patient's emotional and physical energy has to be focused on coping with cancer. The survey results suggest that the risk of neutropenia and the impact this can have on patients' clinical care and quality of life must be taken even more seriously," said Kay Leonard, European Oncology Nursing Society (EONS) Board Member.  "It is important to ensure patients are receiving the most effective and appropriate prophylactic therapies as early as possible to help achieve positive treatment outcomes and prevent related complications before they develop," she added.

When questioned about factors that may impact chemotherapy, almost all (97 percent) of the nurse respondents agreed that developing an infection or low white blood cell count can cause a delay in treatment, with interruptions in chemotherapy impacting overall effectiveness of the treatment (73 percent).  Nearly seven out of ten nurses (68 percent) felt that a patient's chances of successful cancer treatment may be lower if there need to be changes in chemotherapy treatment, such as reducing the dosage, delaying treatment or substituting drugs, and over two-thirds (70 percent) of nurses questioned agreed that lowering the dose may have an impact on the outcome of treatment, even if the dose is adjusted or increased at a later date (63 percent).

The survey was conducted by the European Oncology Nursing Society (EONS) in nine European countries to explore current perceptions and issues relating to cancer therapy and infection, specifically neutropenia/febrile neutropenia (FN).

Neutropenia means that there is an abnormally low level of infection-fighting white blood cells (neutrophils) in the body and it is a common and potentially dangerous side effect of some chemotherapeutic regimens, leading to a heightened risk of infection, sometimes life-threatening amongst cancer patients. Severe neutropenia and febrile neutropenia require hospitalisation in high-risk cases. A secondary outcome of febrile neutropenia can be the delay in scheduled chemotherapy, keeping patients from getting their full dose at the right time with a potential impact on chemotherapy outcome.  Hospitalisation also results in an interruption to a patient's daily life, versus their planned chemotherapy treatment, which usually takes place on an outpatient basis.

Treatments are available to prevent and manage chemotherapy-induced infections and significant progress has been made in the development of "proactive" therapies to help manage side effects of chemotherapy. Guidelines developed by the European Organization for Research and Treatment of Cancer (EORTC) state that recombinant human granulocyte colony-stimulating factors (G-CSFs) are available to treat or prevent neutropenia and therefore reduce associated complications. This is reflected in 54 percent of nurse survey respondents who confirmed using G-CSFs prophylactically to prevent febrile neutropenia in patients receiving chemotherapy. An additional 27 percent of nurses reported using both G-CSFs and antibiotics.

However, 85 percent of nurse respondents expressed concerns regarding patients' concordance to treatment.  Moreover, it was reported by patients in the survey that access to and provision of treatments that prevent infection varies widely across Europe.

"Up to 1 in 10 patients hospitalised with febrile neutropenia might die as a result of it - this is a serious condition and it is vital that patients are provided with information about their risk of neutropenia and developing an infection, as a result of their chemotherapy," said Dr. Matti S. Aapro, Director, Multidisciplinary Oncology Institute, Genolier, Switzerland. "The prevention of neutropenia offers patients the possibility to continue with their chemotherapy schedule uninterrupted, increasing the probability of a more successful treatment outcome. G-CSFs, administered once per chemotherapy cycle, may encourage patient compliance if used prophylactically," he added.

A significant number of patient respondents did not appear to fully understand their risk of developing febrile neutropenia. Conversely, 97 percent of nurses questioned stated that they discuss the personal risks of getting an infection/febrile neutropenia with patients sometime before, during or after their chemotherapy, which suggests a need for improvement in communication between patients and their healthcare providers.

The Preventing Febrile Neutropenia - Staying on Track with Chemotherapy survey was conducted by PatientView in collaboration with the European Oncology Nursing Society (EONS), and is sponsored by Amgen. This research is representative of the company's ongoing efforts to assess better ways to reduce neutropenia and its consequences in patients with cancer.