Greater physical and psychological symptom burden in patients with grade 3/4 chemotherapy-induced neutropenia

Support Cancer Ther. 2006 Apr 1;3(3):173-7. doi: 10.3816/SCT.2006.n.015.


Background: Neutropenia is a common toxicity caused by chemotherapy that can lead to febrile neutropenia, infection, and dose reductions or delays that can diminish the efficacy of treatment. The relationship between chemotherapy-induced neutropenia and symptom burden is less well known. Recent data show a trend toward a greater incidence, duration, and severity of other toxicities of chemotherapy in patients with grade 4 neutropenia.

Patients and methods: This retrospective study examined the relationship between symptom burden and neutropenia in the first cycle of chemotherapy, using the Cancer Care Monitor (CCM) to evaluate symptom burden in 5 domains: Physical Symptoms, Side Effects, Distress, Despair, and Neutropenia Index. Data were collected from the medical records of 51 adult patients with cancer who had been treated with standard 21-day regimens without granulocyte colony-stimulating factor support. Patients had been assessed before treatment and at midcycle (days 6-14) for complete blood cell count and symptom burden.

Results: The symptom burden in all 5 CCM domains was greater in patients with grade 3 (n = 8) or grade 4 (n = 16) neutropenia at midcycle than in patients with grade 0-2 neutropenia. Age, chemotherapy regimen or dose, and day of midcycle assessment were not significantly correlated with the severity of symptoms.

Conclusion: Understanding the relationship between symptom burden and chemotherapy-induced neutropenia can lead to more appropriate use of supportive care in patients treated with chemotherapy.