How Costly is Febrile Neutropenia in Patients with Metastatic Cancer?

Febrile neutropenia (FN) is a frequent and often costly complication for patients with metastatic cancer receiving myelosuppressive chemotherapy. When patients develop FN, the likelihood of infection and serious consequences often necessitates hospitalization for urgent evaluation, ongoing monitoring, and the use of intravenous antibiotics. It can also have an impact on overall patient care by causing delays to medication doses or discontinuation of chemotherapy. This is particularly true for patients with hematologic malignancies.

According to a retrospective cohort study published in the Journal of Oncology Practice, FN occurred in up to 21 percent of metastatic cancer patients studied. Often, these patients required lengthy – and costly – hospitalizations.

“Although studies have evaluated the risk and consequences of febrile neutropenia among patients receiving cancer chemotherapy in U.S. clinical practice, none have focused on a broad group of patients with metastatic disease,” wrote first author Derek Weycker, PhD, and colleagues.

To investigate the prevalence and cost associated with FN in patients with metastatic solid tumors, Dr. Weycker and co-authors conducted a large retrospective cohort study of data from two large private health plans providing coverage to more than 30 million people annually. The current study looked at patients undergoing myelosuppressive chemotherapy from July 2006 to December 2011 for a tumor in one of five areas:

  • 15,309 patients with breast cancer
  • 21,994 patients with lung cancer
  • 16,934 patients with colorectal cancer
  • 7,435 patients with ovarian cancer
  • 4,668 patients with prostate cancer

For each patient, the researchers identified the first chemotherapy course and each cycle therein, along with each episode – if any – of FN experienced during that course.

While there is no specific diagnostic code for febrile neutropenia in health-care claims databases, the authors noted, they used an algorithm that combined the various codes for neutropenia, fever, and infection.

The most common chemotherapy regimens were: paclitaxel for breast cancer (18%); carboplatin + paclitaxel for lung cancer (23%); oxaliplatin, fluorouracil, and leucovorin for colorectal cancer (23%); carboplatin + paclitaxel for ovarian cancer (49%); and docetaxel for prostate cancer (68%).

Investigators found that, across the cancers studies, the percentage of patients who developed FN during their chemotherapy course ranged from 13.1 percent to 20.6 percent, with lung cancer patients experiencing the greatest frequency of FN (TABLE).

FN occurred most often in the first cycle of chemotherapy and required hospitalization in 89 to 94 percent of patients depending on cancer type. For those who were hospitalized, mean length of stay ranged from 7.0 days (95% CI 6.7-7.3) for breast cancer patients to 7.5 days (95% CI 7.2-7.8) for patients with colorectal cancer.

Hospital mortality, on the other hand, varied widely among cancer types: 3.9 percent for ovarian cancer to 10.3 percent for lung cancer.
Hospitalization also led to significant costs – from a low of $16,291 per FN episode for patients with prostate cancer to a high of $19,456 for patients with ovarian cancer.

Each episode of FN also led to increased costs for those requiring outpatient care only – from $1,550 (95% CI $1,305-1,846) for patients with lung cancer to $1,769 (95% CI $1,154-2,515) for patients with prostate cancer.

“The results of this study suggest that the incidence of FN among patients with metastases from common cancers, along with the clinical and economic consequences of this condition, is considerable,” Dr. Dreycker and colleagues concluded. For patients with hematologic malignancies, who are often automatically admitted to the hospital for FN episodes, these results also have clinical and economic implications.

However, the authors noted, this study did not include other possible FN-related consequences, such as “dose delays and reductions, early termination of planned chemotherapy, and increased antimicrobial use, all of which may lead to suboptimal patient outcomes.”


Weycker D, Li X, Edelsberg J, et al. Risk and consequences of chemotherapy-induced febrile neutropenia in patients with metastatic solid tumors. J Oncol Pract. 2015;11:47-54.

TABLE. Risk of FN Among Patients with Metastatic Solid Tumors

Tumor Type n Chemotherapy Course 95% CI
Breast cancer 15,309 15.8% 15.2-16.4
Lung cancer 21,994 20.6% 20.1-21.2
Colorectal cancer 16,934 13.7% 13.2-14.2
Ovarian cancer 7,435 13.1% 12.3-13.9
Prostate cancer 4,668 17.7% 16.6-18.8