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Incidence, Management and Predictors of Chemotherapy-Induced Neutropenia among Adult Solid Cancer Patients at the University of Gondar Comprehensive and Specialized Hospital: Retrospective Follow up Study

Samuel Agegnew Wondm, Sumeya Tadesse, Dessie Abebaw, Samuel Berihun Dagnew, Ephrem Mebratu Dagnew, Eyayaw Ashete Belachew, Bekalu Kebede

Background: Chemotherapy-induced neutropenia is the most well-known oncologic emergencies and the most common hematologic toxicity of chemotherapy. A few studies have been carried out to assess the incidence and management practice of chemotherapy-induced neutropenia in Ethiopia.

Objective: The study was conducted to assess incidence, management, and predictors of chemotherapy-induced neutropenia among adult solid cancer patients at the University of Gondar Comprehensive and Specialized Hospital (UOGCSH).

Methods: A hospital-based retrospective follow-up study was conducted among adult solid cancer patients attending between January 1, 2017, to February 30, 2021, at the oncology ward of UOGCSH. A structured data abstraction format was used to collect data from patients' medical charts. Data were analyzed using STATA version 14.2. Bivariate and multivariable logistic regression analysis was used to identify independent predictors of chemotherapy-induced neutropenia and P-value, <0.05 was considered statistically significant. Analysis of variance was used to compare the difference in recovery time of neutropenia between different treatment regimens.

Results: A total of 416 patients were included in the study with a mean age of the patient 50.56 ± 14.4 years. The cumulative incidence of neutropenia was 62.3% (95% CI 57.9-67.1) and 13% of them developed infections. Advanced stage of cancer, poor performance status, patients taking triple treatment modality, lower baseline white blood cell count, elevated lactated dehydrogenase, cisplatin-paclitaxel, doxorubicin-cyclophosphamide, doxorubicincyclophosphamide followed by four cycles of paclitaxel and patients with two or more comorbidities were found to be predictors for chemotherapy-induced neutropenia (P<0.05). The use of filgrastim has significantly reduced the duration of neutropenia recovery time by 33.28 days (P=0.0001) as compared to chemotherapy delay.

Conclusion: The incidence of neutropenia was common in solid cancer and it is multifactorial. Health care professionals should be aware of these risk factors and greater effort is needed to reduce the risk of neutropenia. Filgrastim was the main management for chemotherapy-induced of neutropenia and it was significantly reduced the duration of neutrophil recovery time.