Administrative and cancer registry data, routinely integrated within modern electronic medical records, can help determine which patients with lymphoma are at the highest risk of dying from chemotherapy, according to a study published in the Journal of the National Comprehensive Cancer Network.
Diffuse large B-cell lymphoma (LBCL) is curable in most patients aged 65 years and older, but this patient population is also highly susceptible to chemotherapy-related death within the first 30 days of treatment. For this reason, nearly one-fourth of elderly patients with B-cell lymphoma do not receive chemotherapy as a part of their treatment.
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In a study led by Adam J Olszewski, MD, Brown University (Providence, RI), researchers used population-based data from Medicare beneficiaries to evaluate risk factors for death and hospitalization during the first month of rituximab-based immunochemotherapy for patients with LBCL.
Researchers identified 5530 patients diagnosed LBCL at age 65 years or older using Medicare claims and Surveillance, Epidemiology, and End Results Program data. All patients initiated outpatient immunochemotherapy containing, at a minimum, rituximab, cyclophosphamide, and vincristine in combination with doxorubicin, mitoxantrone, or etoposide.
Overall, records showed that 94% of patients received doxorubicin-containing immunochemotherapy and 66% received granulocyte colony-stimulating factor (G-CSF) during their first treatment cycle. With a median follow-up of 5.7 years, the median overall survival was 7 years and the estimated 5-year survival rate was 60%.
The cumulative incidence of death was 2.2% at 180 days from chemotherapy initiation. The most common causes of death within the first 30 days of treatment were lymphoma (72%), heart disease (9%), septicemia (3%), and cerebrovascular events (3%). Factors that were associated with an increased risk of death were: older age (75 years or older), disease-related symptoms (B-symptoms), poor performance status, chronic kidney disease, use of mobility aids (cane, walker, wheelchair), prior hospitalization within the last 12 months, and upper endoscopy within the past 12 months. Access to this data could help clinicians to better stratify patients based on risk.
In addition, the researchers also found that early administration G-CSF was associated with lower probability of early death in patients considered to be high risk.
While more research is necessary to test the validity of their results, researchers concluded that data culled from electronic health record datas and integrated into digital support tools could help to enhance provider decision-making.
"The first month of treatment, when patients are compromised both by active lymphoma and toxicities of chemotherapy, is a period of particular concern, as nearly one in four patients were hospitalized during that time,” said Dr Olszewski.
“While comprehensive geriatric assessment remains the gold standard for risk assessment, our study suggests that readily available data from electronic medical records can help identify the high-risk factors in practice."
