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Cancer Research and Treatment > Epub ahead of print
doi: https://doi.org/10.4143/crt.2023.784    [Epub ahead of print]
Impact of Patient Sex on Adverse Events and Unscheduled Utilization of Medical Services in Cancer Patients Undergoing Adjuvant Chemotherapy: A Multicenter Retrospective Cohort Study
Songji Choi1 , Seyoung Seo2 , Ju Hyun Lee1, Koung Jin Suh1, Ji-Won Kim1, Jin Won Kim1, Se Hyun Kim1, Yu Jung Kim1, Keun-Wook Lee1, Jwa Hoon Kim2,3, Tae Won Kim2, Yong Sang Hong2, Sun Young Kim2, Jeong Eun Kim2, Sang-We Kim2, Dae Ho Lee2, Jae Cheol Lee2, Chang-Min Choi2, Shinkyo Yoon2, Su-Jin Koh4, Young Joo Min4, Yongchel Ahn5, Hwa Jung Kim6, Jin Ho Baek7, Sook Ryun Park2 , Jee Hyun Kim1
1Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
2Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
3Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
4Division of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
5Department of Hematology and Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
6Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
7Department of Oncology/Hematology, Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, Korea

*Presented in part at the 15th Annual Meeting of the Korean Society of Medical Oncology & 2022 International Conference (KSMO 2022), Seoul, Korea, 2-3 September 2022.
Correspondence  Sook Ryun Park ,Tel: 82-2-3010-3206, Fax: 82-2-3010-6961, Email: srpark@amc.seoul.kr
Jee Hyun Kim ,Tel: 82-31-787-7022, Fax: 82-31-787-4098, Email: jhkimmd@snu.ac.kr
Received: June 22, 2023;  Accepted: November 6, 2023.  Published online: November 7, 2023.
*Songji Choi and Seyoung Seo contributed equally to this work.
ABSTRACT
Purpose
The female sex is reported to have a higher risk of adverse events (AEs) from cytotoxic chemotherapy. Few studies examined the sex differences in AEs and their impact on the use of medical services during adjuvant chemotherapy. This sub-study aimed to compare the incidence of any grade and grade ≥ 3 AEs, healthcare utilization, chemotherapy completion rate, and dose intensity according to sex.
Materials and Methods
This is a sub-study of a multicenter cohort conducted in Korea that evaluated the impact of healthcare reimbursement on AE evaluation in patients who received adjuvant chemotherapy between September 2013 and December 2016 at four hospitals in Korea.
Results
A total of 1,170 patients with colorectal, gastric, or non–small cell lung cancer were included in the study. Female patients were younger, had fewer comorbidities, and experienced less postoperative weight loss of > 10%. Females had significantly higher rates of any grade AEs including nausea, abdominal pain, stomatitis, vomiting, and neutropenia, and experienced more grade ≥ 3 neutropenia, nausea, and vomiting. The dose intensity of chemotherapy was significantly lower in females, and they also experienced more frequent dose reduction after the first cycle. Moreover, female patients receiving platinum-containing regimens had significantly higher rates of unscheduled outpatient visits.
Conclusion
Our study found that females experienced a higher incidence of multiple any-grade AEs and severe neutropenia, nausea, and vomiting, across various cancer types, leading to more frequent dose reductions. Physicians should be aware of sex differences in AEs for chemotherapy decisions.
Key words: Sex characteristics, Adverse events, Adjuvant chemotherapy
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