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.
Additionally, the study found that patients over age 60 had more than twice the risk of being under-treated. Other risk factors for under-treatment included having an advanced stage of NHL, poor treatment practices at the treatment facility, and failure to use white cell boosters preventatively.
Other researchers on this study included David C. Dale of University of Washington, Jonathan Friedberg of the University of Rochester Medical Center, Jeffrey Crawford of Duke University, and Richard I. Fisher of the University of Rochester Medical Center. The study was funded by Amgen.
The Awareness of Neutropenia in Chemotherapy (ANC) Study Group, based at the Wilmot Cancer Center at University of Rochester Medical Center, was formed in September 2000 to develop more accurate prediction models for neutropenia. Directed by leading U.S. hematologists and oncologists Lyman, Dale, and Crawford, the group focuses on neutropenia awareness, treatment effectiveness and long-term survival. The group also studies the cost and quality-of-life impacts of chemotherapy-induced neutropenia. The ANC Study group is supported by a grant from Amgen.