Lung cancer, compared with other solid
tumors, is associated with high mortality rates from
febrile neutropenia. The risk factors associated with in-hospital mortality were identified and compared for patients with
lung cancer and patients with other solid
tumors. Hospitalization data from the University Health Consortium database inclusive of 2004 to 2012 were analyzed. The study population included all adult patients with solid
tumors who developed
neutropenia.
Cancer type, the presence of
neutropenia, and further subgroups were determined using International Classification of Diseases, 9th revision, Clinical Modification codes. The primary study outcome was in-hospital mortality in
lung cancer patients versus those with other solid
tumors. Further analysis concentrated on comparisons of the 2 groups. The analysis included data from 11,111
lung cancer patients and 49,975 patients with other solid
tumors. Overall, 4290 patients (7.0%) died.
Lung cancer was associated with highest mortality (11.2% compared with other solid
tumors, 6.1%; P < .0001). The
lung cancer patients were older and more likely to have multiple comorbidities, and the risk of mortality was directly related to the number of comorbidities. Four additional risk factors for mortality were identified:
pneumonia,
sepsis, any
infection, and intensive care unit stay.
Pneumonia occurred more commonly in the
lung cancer patients (26.4% vs. 10.3%) and was associated with comorbid
pulmonary disease, which also occurred more often in the
lung cancer patients (52.1% vs. 24.0%). We found that
lung cancer patients presenting with
febrile neutropenia were older, had more comorbidities, had a greater incidence of comorbid
pulmonary disease, and were more likely to have
pneumonia. Awareness of these risk factors for mortality should guide clinicians for more personalized approaches to
chemotherapy, supportive care decisions,
pneumonia and comorbidities.