Approximately half of patients with aggressive non-Hodgkin's lymphoma (NHL) fail to receive the recommended dose and schedule of chemotherapy, reducing their chances for remission or cure.
The study of 4,522 patients in 567 oncology practices nationwide, led by the University of Rochester Medical Center, is the largest of its kind to date. Published September 20, 2004 in the Journal of Clinical Oncology (online edition), the study found that 48 to 53 percent of NHL patients received less than 85 percent of the recommended chemotherapy dose intensity due to treatment delays of at least one week or dose reduction.
"The data point to an alarming pattern in the treatment of patients with aggressive and potentially curable NHL: Too many patients do not receive the chemotherapy doses that they need in order to have the best chance of complete remission or cure," said Gary Lyman, M.D., lead researcher on the study and director of health services and outcomes research at the Wilmot Cancer Center at the University of Rochester Medical Center. In December 2003, Lyman presented findings of a similar study of breast cancer patients showing that more than half were under-treated, reducing their chances for remission or cure.
The reasons for under-treatment included both planned and unplanned reductions in treatment. Planned reductions were expected from the beginning of treatment. Unplanned reductions occurred due to treatment complications. For example, a common, potentially serious side effect of chemotherapy treatment is neutropenia, a shortage of infection-fighting white blood cells. Chemotherapy drugs are designed to destroy cancer cells, but unfortunately healthy cells are also killed, including the white blood cells that protect against infection. When a patient's white blood cell count drops too low, they are at increased risk of developing infections and chemotherapy often has to be delayed until these essential white blood cells are replenished.
While white cell boosters, known as colony-stimulating factors, can be given to manage neutropenia, the study found that only half of patients received this treatment as a preventative measure.