Research has revealed regional disparities in outcomes for patients who are hospitalized with chemotherapy-related febrile neutropenia in the United States. 

The data suggest that patients in the South are most likely to be hospitalized with chemotherapy-related febrile neutropenia, but patients in the West have the highest all-cause in-hospital mortality and the highest hospital costs. 

These findings were presented in a poster at the 2023 NCCN Annual Conference by Akhil Jain, MD, of Mercy Catholic Medical Center in Darby, Pennsylvania, and colleagues.

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The researchers evaluated patients from the National Inpatient Sample who were hospitalized for chemotherapy-related febrile neutropenia during 2016-2019. 

The cohort included 170,525 patients from across the United States — 37.4% in the South, 24.1% in the Midwest, 20.2% in the West, and 18.3% in the Northeast. 

The primary outcome was the all-cause in-hospital mortality rate, which was 5.8% in the West, compared with 4.8% in the Midwest and the South, and 4.9% in the Northeast (P =.007).

A multivariable analysis showed a 38% increased risk for all-cause mortality in the West compared with the Midwest (adjusted odds ratio [aOR], 1.38; P <.001). There were no significant differences between the Midwest and the South or the Northeast.

Severe sepsis with septic shock was more likely among patients in the West (aOR, 1.36; P <.001) or South (aOR, 1.21; P =.012) than among those in the Northeast. 

Severe sepsis without septic shock was more likely among patients in the West than among those in the Northeast as well (aOR, 1.70; P <.001), but there were no significant differences between the other regions.

There were no significant differences between the regions with regard to length of hospital stay or risk of 30-day readmission. However, hospitalization costs were significantly higher in the Northeast, South, and West, compared with the Midwest (P <.001 for all). Overall, costs were highest in the West.

“These findings highlight the urgent need for standardized care standards and quality metrics for these high-risk patients in order to eliminate regional discrepancies and ensure uniform national outcomes,” Dr Jain said. “Further studies are needed to identify patients at higher risk of poor outcomes with febrile neutropenia.”


Jain A, Deshpande S, Desai K, et al. Disparities in outcomes of chemotherapy-related febrile neutropenia patients: A nationwide study of hospitalizations. NCCN 2023. March 31 – April 2, 2023. Abstract CLO23-048.