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Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia

Several comorbidities have recently been shown to affect risk of chemotherapy‐induced febrile neutropenia (FN). Here, we evaluated the added predictive value of these comorbidities beyond established FN risk factors. A retrospective cohort study was conducted among adult patients diagnosed with canc...

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Autores principales: Li, Yanli, Family, Leila, Chen, Lie H., Page, John H., Klippel, Zandra, Xu, Lanfang, Chao, Chun R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089155/
https://www.ncbi.nlm.nih.gov/pubmed/29953736
http://dx.doi.org/10.1002/cam4.1580
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author Li, Yanli
Family, Leila
Chen, Lie H.
Page, John H.
Klippel, Zandra
Xu, Lanfang
Chao, Chun R.
author_facet Li, Yanli
Family, Leila
Chen, Lie H.
Page, John H.
Klippel, Zandra
Xu, Lanfang
Chao, Chun R.
author_sort Li, Yanli
collection PubMed
description Several comorbidities have recently been shown to affect risk of chemotherapy‐induced febrile neutropenia (FN). Here, we evaluated the added predictive value of these comorbidities beyond established FN risk factors. A retrospective cohort study was conducted among adult patients diagnosed with cancer and treated with chemotherapy at Kaiser Permanente Southern California between 2000 and 2009. The study cohort was equally split into training and validation datasets to develop and evaluate the performance of FN risk prediction models in the first chemotherapy cycle. A reference model was developed based on the model proposed by Lyman et al (Cancer 2011;117:1917). A new model was developed by incorporating the newly identified comorbidities such as rheumatoid conditions and thyroid disorders into the reference model. Area under the receiver operating characteristic curve (AUROCC), risk reclassification, and integrated discrimination improvement (IDI) were used to evaluate the potential improvement of FN risk prediction by incorporating comorbidities. A total of 15 279 patients were included; 4.2% experienced FN in the first chemotherapy cycle. Including comorbidities in FN risk prediction did not improve AUROCC (reference model 0.71 vs new model 0.72). A significant improvement in individual‐level FN risk prediction was indicated by IDI (P = .02). However, significant improvement in risk reclassification was not observed overall (although 6% of all patients were more accurately classified for their FN risk level, 5% were less accurately classified) or when examining predicted FN risk among patients who did and did not develop FN. Incorporating several new comorbidities into FN prediction led to improved FN risk prediction in the first chemotherapy cycle, although the observed improvements were small and might not be clinically relevant.
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spelling pubmed-60891552018-08-17 Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia Li, Yanli Family, Leila Chen, Lie H. Page, John H. Klippel, Zandra Xu, Lanfang Chao, Chun R. Cancer Med Cancer Prevention Several comorbidities have recently been shown to affect risk of chemotherapy‐induced febrile neutropenia (FN). Here, we evaluated the added predictive value of these comorbidities beyond established FN risk factors. A retrospective cohort study was conducted among adult patients diagnosed with cancer and treated with chemotherapy at Kaiser Permanente Southern California between 2000 and 2009. The study cohort was equally split into training and validation datasets to develop and evaluate the performance of FN risk prediction models in the first chemotherapy cycle. A reference model was developed based on the model proposed by Lyman et al (Cancer 2011;117:1917). A new model was developed by incorporating the newly identified comorbidities such as rheumatoid conditions and thyroid disorders into the reference model. Area under the receiver operating characteristic curve (AUROCC), risk reclassification, and integrated discrimination improvement (IDI) were used to evaluate the potential improvement of FN risk prediction by incorporating comorbidities. A total of 15 279 patients were included; 4.2% experienced FN in the first chemotherapy cycle. Including comorbidities in FN risk prediction did not improve AUROCC (reference model 0.71 vs new model 0.72). A significant improvement in individual‐level FN risk prediction was indicated by IDI (P = .02). However, significant improvement in risk reclassification was not observed overall (although 6% of all patients were more accurately classified for their FN risk level, 5% were less accurately classified) or when examining predicted FN risk among patients who did and did not develop FN. Incorporating several new comorbidities into FN prediction led to improved FN risk prediction in the first chemotherapy cycle, although the observed improvements were small and might not be clinically relevant. John Wiley and Sons Inc. 2018-06-28 /pmc/articles/PMC6089155/ /pubmed/29953736 http://dx.doi.org/10.1002/cam4.1580 Text en © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Cancer Prevention
Li, Yanli
Family, Leila
Chen, Lie H.
Page, John H.
Klippel, Zandra
Xu, Lanfang
Chao, Chun R.
Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
title Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
title_full Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
title_fullStr Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
title_full_unstemmed Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
title_short Value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
title_sort value of incorporating newly identified risk factors into risk prediction for chemotherapy‐induced febrile neutropenia
topic Cancer Prevention
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089155/
https://www.ncbi.nlm.nih.gov/pubmed/29953736
http://dx.doi.org/10.1002/cam4.1580
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