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Racial disparity in taxane‐induced neutropenia among cancer patients
Background Large interindividual variations have been reported in chemotherapy‐induced toxicities. Little is known whether racial disparities exist in neutropenia associated with taxanes. Methods Patients with a diagnosis of primary cancer who underwent chemotherapy with taxanes were identified from...
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| Published in: | Cancer medicine (Malden, MA) MA), 2021-10, Vol.10 (19), p.6767-6776 |
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| creator | Zheng, Neil S. Wang, Fei Agarwal, Rajiv Carroll, Robert J. Wei, Wei‐Qi Berlin, Jordan Shu, Xiao‐Ou |
| description | Background
Large interindividual variations have been reported in chemotherapy‐induced toxicities. Little is known whether racial disparities exist in neutropenia associated with taxanes.
Methods
Patients with a diagnosis of primary cancer who underwent chemotherapy with taxanes were identified from Vanderbilt University Medical Center's Synthetic Derivative. Multinomial regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of neutropenia associated with race, with adjustments for demographic variables, baseline neutrophil count, chemotherapy‐related information, prior treatments, and cancer site.
Results
A total of 3492 patients were included in the study. Compared with White patients, grade 2 or higher neutropenia was more frequently recorded among Black patients who received taxanes overall (42.2% vs. 32.7%, p |
| doi_str_mv | 10.1002/cam4.4181 |
| format | article |
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Large interindividual variations have been reported in chemotherapy‐induced toxicities. Little is known whether racial disparities exist in neutropenia associated with taxanes.
Methods
Patients with a diagnosis of primary cancer who underwent chemotherapy with taxanes were identified from Vanderbilt University Medical Center's Synthetic Derivative. Multinomial regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of neutropenia associated with race, with adjustments for demographic variables, baseline neutrophil count, chemotherapy‐related information, prior treatments, and cancer site.
Results
A total of 3492 patients were included in the study. Compared with White patients, grade 2 or higher neutropenia was more frequently recorded among Black patients who received taxanes overall (42.2% vs. 32.7%, p < 0.001) or paclitaxel (43.0% vs. 36.7%, p < 0.001) but not among those who received docetaxel (32.0% vs. 30.2%, p = 0.821). After adjustments for multiple covariates, Black patients who received chemotherapy with any taxanes had significantly higher risk of grade 2 (OR = 1.53; 95% CI = 1.09–2.14) and grade 3 (OR = 1.91; 95% CI = 1.36–2.67) neutropenia but comparable risk of grade 4 neutropenia (OR = 1.19; 95% CI = 0.79–1.79). Similar association patterns were observed for Black patients who specifically received paclitaxel, but a null association was found for those treated with docetaxel.
Conclusion
Black cancer patients treated with taxanes for any cancer had a higher risk of neutropenia compared with their White counterparts, especially those who received paclitaxel. More research is needed to understand the mechanism(s) underlying this racial disparity in order to enhance the delivery of patient‐centered oncology.
After accounting for baseline neutropenia count, patient characteristics and other treatments received, Black patients who received chemotherapy with taxanes had a greater risk for neutropenia compared with their White counterparts, especially for those who received paclitaxel. This is critically important for treatment planning and dose adjustments, expectation setting, and physician awareness for the potential for increased infections or febrile episodes during periods of neutropenia in Black patients. Our findings call for further investigations on this disparity, particularly in clinical trial settings, as well as on the underlying mechanisms.</description><identifier>ISSN: 2045-7634</identifier><identifier>EISSN: 2045-7634</identifier><identifier>DOI: 10.1002/cam4.4181</identifier><identifier>PMID: 34547180</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>Age ; Aged ; Body mass index ; Cancer ; Cancer therapies ; Chemotherapy ; Clinical Cancer Research ; Codes ; Electronic health records ; Female ; healthcare disparities ; Healthcare Disparities - trends ; Humans ; Laboratories ; Leukocytes (neutrophilic) ; Male ; Middle Aged ; neoplasms ; Neoplasms - blood ; Neoplasms - drug therapy ; Neoplasms - pathology ; Neutropenia ; Neutropenia - chemically induced ; Neutrophils ; Paclitaxel ; Patients ; Race ; Race Factors ; Radiation therapy ; Regression analysis ; Taxanes ; Taxoids - adverse effects ; Terminology ; Variables</subject><ispartof>Cancer medicine (Malden, MA), 2021-10, Vol.10 (19), p.6767-6776</ispartof><rights>2021 The Authors. published by John Wiley & Sons Ltd.</rights><rights>2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.</rights><rights>2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5091-cc8ea1cf2b31d5cae90008f689a37d757c7f5edaf50879c757b2285e8bd16cd43</citedby><cites>FETCH-LOGICAL-c5091-cc8ea1cf2b31d5cae90008f689a37d757c7f5edaf50879c757b2285e8bd16cd43</cites><orcidid>0000-0002-0711-8314 ; 0000-0001-8737-0773</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2579499720/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2579499720?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,11562,25753,27924,27925,37012,44590,46052,46476,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34547180$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zheng, Neil S.</creatorcontrib><creatorcontrib>Wang, Fei</creatorcontrib><creatorcontrib>Agarwal, Rajiv</creatorcontrib><creatorcontrib>Carroll, Robert J.</creatorcontrib><creatorcontrib>Wei, Wei‐Qi</creatorcontrib><creatorcontrib>Berlin, Jordan</creatorcontrib><creatorcontrib>Shu, Xiao‐Ou</creatorcontrib><title>Racial disparity in taxane‐induced neutropenia among cancer patients</title><title>Cancer medicine (Malden, MA)</title><addtitle>Cancer Med</addtitle><description>Background
Large interindividual variations have been reported in chemotherapy‐induced toxicities. Little is known whether racial disparities exist in neutropenia associated with taxanes.
Methods
Patients with a diagnosis of primary cancer who underwent chemotherapy with taxanes were identified from Vanderbilt University Medical Center's Synthetic Derivative. Multinomial regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of neutropenia associated with race, with adjustments for demographic variables, baseline neutrophil count, chemotherapy‐related information, prior treatments, and cancer site.
Results
A total of 3492 patients were included in the study. Compared with White patients, grade 2 or higher neutropenia was more frequently recorded among Black patients who received taxanes overall (42.2% vs. 32.7%, p < 0.001) or paclitaxel (43.0% vs. 36.7%, p < 0.001) but not among those who received docetaxel (32.0% vs. 30.2%, p = 0.821). After adjustments for multiple covariates, Black patients who received chemotherapy with any taxanes had significantly higher risk of grade 2 (OR = 1.53; 95% CI = 1.09–2.14) and grade 3 (OR = 1.91; 95% CI = 1.36–2.67) neutropenia but comparable risk of grade 4 neutropenia (OR = 1.19; 95% CI = 0.79–1.79). Similar association patterns were observed for Black patients who specifically received paclitaxel, but a null association was found for those treated with docetaxel.
Conclusion
Black cancer patients treated with taxanes for any cancer had a higher risk of neutropenia compared with their White counterparts, especially those who received paclitaxel. More research is needed to understand the mechanism(s) underlying this racial disparity in order to enhance the delivery of patient‐centered oncology.
After accounting for baseline neutropenia count, patient characteristics and other treatments received, Black patients who received chemotherapy with taxanes had a greater risk for neutropenia compared with their White counterparts, especially for those who received paclitaxel. This is critically important for treatment planning and dose adjustments, expectation setting, and physician awareness for the potential for increased infections or febrile episodes during periods of neutropenia in Black patients. Our findings call for further investigations on this disparity, particularly in clinical trial settings, as well as on the underlying mechanisms.</description><subject>Age</subject><subject>Aged</subject><subject>Body mass index</subject><subject>Cancer</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Clinical Cancer Research</subject><subject>Codes</subject><subject>Electronic health records</subject><subject>Female</subject><subject>healthcare disparities</subject><subject>Healthcare Disparities - trends</subject><subject>Humans</subject><subject>Laboratories</subject><subject>Leukocytes (neutrophilic)</subject><subject>Male</subject><subject>Middle Aged</subject><subject>neoplasms</subject><subject>Neoplasms - blood</subject><subject>Neoplasms - drug therapy</subject><subject>Neoplasms - pathology</subject><subject>Neutropenia</subject><subject>Neutropenia - chemically induced</subject><subject>Neutrophils</subject><subject>Paclitaxel</subject><subject>Patients</subject><subject>Race</subject><subject>Race Factors</subject><subject>Radiation therapy</subject><subject>Regression analysis</subject><subject>Taxanes</subject><subject>Taxoids - adverse effects</subject><subject>Terminology</subject><subject>Variables</subject><issn>2045-7634</issn><issn>2045-7634</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp1kcFu1DAQhiNERavSAy-AInHisK3t2LF9QapWFCoVIVXt2RqPncWrrB2cpLA3HoFn5EnwdkvVHvDF1vjTNzP6q-oNJaeUEHaGsOGnnCr6ojpihIuFbBv-8sn7sDoZxzUpRxLWSvqqOmy44JIqclRdXAMG6GsXxgFymLZ1iPUEPyH6P79-h-hm9K6Ofp5yGnwMUMMmxVWNENHneoAp-DiNr6uDDvrRnzzcx9Xtxceb5efF1ddPl8vzqwUKoukCUXmg2DHbUCcQvC5Tqa5VGhrppJAoO-EddIIoqbEULGNKeGUdbdHx5ri63HtdgrUZcthA3poEwdwXUl4ZyFPA3htLmtZRz5FLxxmzFizjpOWW2kY3SIrrw941zHbjHZY9MvTPpM9_YvhmVunOKK4Fk6II3j0Icvo--3Ey6zTnWPY3TEjNtZZs1-b9nsKcxjH77rEDJWaXoNklaHYJFvbt05EeyX95FeBsD_wIvd_-32SW51_4vfIvMIimgg</recordid><startdate>202110</startdate><enddate>202110</enddate><creator>Zheng, Neil S.</creator><creator>Wang, Fei</creator><creator>Agarwal, Rajiv</creator><creator>Carroll, Robert J.</creator><creator>Wei, Wei‐Qi</creator><creator>Berlin, Jordan</creator><creator>Shu, Xiao‐Ou</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M7P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-0711-8314</orcidid><orcidid>https://orcid.org/0000-0001-8737-0773</orcidid></search><sort><creationdate>202110</creationdate><title>Racial disparity in taxane‐induced neutropenia among cancer patients</title><author>Zheng, Neil S. ; Wang, Fei ; Agarwal, Rajiv ; Carroll, Robert J. ; Wei, Wei‐Qi ; Berlin, Jordan ; Shu, Xiao‐Ou</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5091-cc8ea1cf2b31d5cae90008f689a37d757c7f5edaf50879c757b2285e8bd16cd43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age</topic><topic>Aged</topic><topic>Body mass index</topic><topic>Cancer</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Clinical Cancer Research</topic><topic>Codes</topic><topic>Electronic health records</topic><topic>Female</topic><topic>healthcare disparities</topic><topic>Healthcare Disparities - trends</topic><topic>Humans</topic><topic>Laboratories</topic><topic>Leukocytes (neutrophilic)</topic><topic>Male</topic><topic>Middle Aged</topic><topic>neoplasms</topic><topic>Neoplasms - blood</topic><topic>Neoplasms - drug therapy</topic><topic>Neoplasms - pathology</topic><topic>Neutropenia</topic><topic>Neutropenia - chemically induced</topic><topic>Neutrophils</topic><topic>Paclitaxel</topic><topic>Patients</topic><topic>Race</topic><topic>Race Factors</topic><topic>Radiation therapy</topic><topic>Regression analysis</topic><topic>Taxanes</topic><topic>Taxoids - adverse effects</topic><topic>Terminology</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zheng, Neil S.</creatorcontrib><creatorcontrib>Wang, Fei</creatorcontrib><creatorcontrib>Agarwal, Rajiv</creatorcontrib><creatorcontrib>Carroll, Robert J.</creatorcontrib><creatorcontrib>Wei, Wei‐Qi</creatorcontrib><creatorcontrib>Berlin, Jordan</creatorcontrib><creatorcontrib>Shu, Xiao‐Ou</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Biological Science Database</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Cancer medicine (Malden, MA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zheng, Neil S.</au><au>Wang, Fei</au><au>Agarwal, Rajiv</au><au>Carroll, Robert J.</au><au>Wei, Wei‐Qi</au><au>Berlin, Jordan</au><au>Shu, Xiao‐Ou</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial disparity in taxane‐induced neutropenia among cancer patients</atitle><jtitle>Cancer medicine (Malden, MA)</jtitle><addtitle>Cancer Med</addtitle><date>2021-10</date><risdate>2021</risdate><volume>10</volume><issue>19</issue><spage>6767</spage><epage>6776</epage><pages>6767-6776</pages><issn>2045-7634</issn><eissn>2045-7634</eissn><abstract>Background
Large interindividual variations have been reported in chemotherapy‐induced toxicities. Little is known whether racial disparities exist in neutropenia associated with taxanes.
Methods
Patients with a diagnosis of primary cancer who underwent chemotherapy with taxanes were identified from Vanderbilt University Medical Center's Synthetic Derivative. Multinomial regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of neutropenia associated with race, with adjustments for demographic variables, baseline neutrophil count, chemotherapy‐related information, prior treatments, and cancer site.
Results
A total of 3492 patients were included in the study. Compared with White patients, grade 2 or higher neutropenia was more frequently recorded among Black patients who received taxanes overall (42.2% vs. 32.7%, p < 0.001) or paclitaxel (43.0% vs. 36.7%, p < 0.001) but not among those who received docetaxel (32.0% vs. 30.2%, p = 0.821). After adjustments for multiple covariates, Black patients who received chemotherapy with any taxanes had significantly higher risk of grade 2 (OR = 1.53; 95% CI = 1.09–2.14) and grade 3 (OR = 1.91; 95% CI = 1.36–2.67) neutropenia but comparable risk of grade 4 neutropenia (OR = 1.19; 95% CI = 0.79–1.79). Similar association patterns were observed for Black patients who specifically received paclitaxel, but a null association was found for those treated with docetaxel.
Conclusion
Black cancer patients treated with taxanes for any cancer had a higher risk of neutropenia compared with their White counterparts, especially those who received paclitaxel. More research is needed to understand the mechanism(s) underlying this racial disparity in order to enhance the delivery of patient‐centered oncology.
After accounting for baseline neutropenia count, patient characteristics and other treatments received, Black patients who received chemotherapy with taxanes had a greater risk for neutropenia compared with their White counterparts, especially for those who received paclitaxel. This is critically important for treatment planning and dose adjustments, expectation setting, and physician awareness for the potential for increased infections or febrile episodes during periods of neutropenia in Black patients. Our findings call for further investigations on this disparity, particularly in clinical trial settings, as well as on the underlying mechanisms.</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>34547180</pmid><doi>10.1002/cam4.4181</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-0711-8314</orcidid><orcidid>https://orcid.org/0000-0001-8737-0773</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Age Aged Body mass index Cancer Cancer therapies Chemotherapy Clinical Cancer Research Codes Electronic health records Female healthcare disparities Healthcare Disparities - trends Humans Laboratories Leukocytes (neutrophilic) Male Middle Aged neoplasms Neoplasms - blood Neoplasms - drug therapy Neoplasms - pathology Neutropenia Neutropenia - chemically induced Neutrophils Paclitaxel Patients Race Race Factors Radiation therapy Regression analysis Taxanes Taxoids - adverse effects Terminology Variables |
| title | Racial disparity in taxane‐induced neutropenia among cancer patients |
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