Profiles and Management of Adult Cancer Patients With Neutropenia Using Granulocyte Colony Stimulating Factors at Kenyatta National Hospital

Abstract

Background: Studies from the West have shown that patient profiles, cancer chemotherapy regimens and certain types of cancers are associated with neutropenia which is managed by granulocyte colony stimulating factors (GCSF). There is scarcity of data that characterize the profiles of patients and management of neutropenia with GCSF in resource-limited settings. Study Objective: The study sought to characterize the profiles of adult cancer patients presenting with the neutropenia and assess its management using GCSF at Kenyatta National Hospital (KNH). Methods: This was a cross-sectional study involving 151 eligible neutropenic participants consecutively selected from the oncology department of KNH from February 2021 to April 2021. The raw data including the patient demographics, clinical characteristics of presenting cancer, cancer treatment modalities, level of severity and management of neutropenia using GCSF were abstracted into a predesigned tool. Participants’ source of funding for treatment and the handling mechanisms for GCSF were also captured. Data Analysis: Data was analyzed using STATA statistical software 23. The Chi-square, student-T and Fisher’s exact tests were used to establish the association between independent variables and the severity of neutropenia. The independent correlates for development and management of neutropenia were determined through regression analysis using forward stepwise logistic method, reporting crude and adjusted odds ratios at 95% confidence limit. Results: The mean age of the participants was 54.2 (+12.3) years with female preponderance (71.5%). Majority of patients (30%) were in stage III, where breast (35.8%) and esophageal cancers dominated. Almost a third was in the fourth cycle where carboplatin (27.2%) and cyclophosphamide-based (25.2%) regimens were most commonly used. Patients using carboplatin-based regimens were four times more likely to develop severe neutropenia than those who did not (AOR 4.3, 95% CI 1.7-10.4, p=0.003). In addition, males were five times more likely to develop severe neutropenia compared to female counterparts (AOR 5.5, 95% CI 2.3-13.5, p<0.001) while patients with higher body surface area (BSA) were nine times more likely compared to those with small BSA (AOR 9.2, 95% CI 1.4-61.9, p=0.022). Participants undergoing concurrent chemo-radiotherapy administration were six times more likely to present

with severe neutropenia than those who did not (AOR 6.1, 95% CI 1.9-19.8, p=0.003). National Hospital Insurance Fund (NHIF) was the most commonly used source of treatment funding for GCSF but 72% of participants did not have access to cold-chain storage facilities. Conclusion: Male gender, higher body surface area, carboplatin-based regimen and chemo-radiotherapy are significantly associated with neutropenia among cancer patients which improves upon timely administration of GCSF. NHIF was the major source of funding for treatment but handling and storage of GCSF was insufficient among participants because it was not financed. Recommendations: Clinicians should be aware that some patient profiles such as male gender and higher body surface area as well as receiving carboplatin based chemotherapy and chemo-radiation are associated with increased risk of neutropenia. Therefore, intensification of monitoring and management of neutropenia should be directed towards these patient categories. Hospitals should encourage patients to widen their sources of funding because NHIF is not sufficient to cater for all the expenses. Large prospective studies should focus on finding out why certain clinical factors are associated with neutropenia and the trends of neutrophil counts on recommended doses of GCSF over prolonged period.