{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:49:31Z","timestamp":1792234171447,"version":"4.4.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2022,3,21]],"date-time":"2022-03-21T00:00:00Z","timestamp":1647820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000147","name":"Canadian Cancer Society","doi-asserted-by":"publisher","award":["2015-703549"],"award-info":[{"award-number":["2015-703549"]}],"id":[{"id":"10.13039\/501100000147","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Malignant gliomas are treated with temozolomide chemoradiotherapy. Because pneumocystis pneumonia (PCP) can occur in patients receiving temozolomide, the product monograph recommends PCP prophylaxis during temozolomide chemoradiotherapy. Not all neuro-oncologists follow these recommendations, though.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a population-based retrospective cohort study of glioma patients undergoing temozolomide chemoradiotherapy 2005 to 2019 in Ontario, Canada. A propensity score model was used to predict the use of PCP prophylaxis. We compared the risk of PCP within 90 days of starting radiotherapy with versus without PCP prophylaxis using inverse probability of treatment weighting (IPTW). We also examined overall survival, hospitalizations, and myelosuppression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 3,225 patients included in the cohort (648 received antibiotics and 2,434 did not). Only 18 patients developed PCP within 90 days of therapy. The IPTW-adjusted absolute risk reduction in PCP with antibiotics was 0.0035 (95% CI, \u22120.0013 to 0.0083), number needed to treat: 288. Neither overall survival nor hospitalization count differed between the groups. The number needed to harm by causing grade 3\/4 neutropenia was 39.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In regions (like Ontario) where PCP is rare, routine PCP prophylaxis with trimethoprim-sulfamethoxazole should not be offered, since the harms may outweigh the benefits.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/neuonc\/noac072","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T20:18:10Z","timestamp":1647634690000},"page":"1738-1748","source":"Crossref","is-referenced-by-count":17,"title":["Effectiveness and safety of pneumocystis pneumonia prophylaxis for patients receiving temozolomide chemoradiotherapy"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4961-237X","authenticated-orcid":false,"given":"Seth A","family":"Climans","sequence":"first","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario , Canada"},{"name":"Department of Oncology, Western University , London, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Grunfeld","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren P","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Neurology, University of Toronto , Toronto, Ontario , Canada"},{"name":"Department of Medical Oncology and Hematology, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin K W","family":"Chan","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,21]]},"reference":[{"issue":"5","key":"2022100306585762400_CIT0001","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1200\/JCO.2002.20.5.1375","article-title":"Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide","volume":"20","author":"Stupp","year":"2002","journal-title":"J Clin Oncol."},{"issue":"19 Pt 1","key":"2022100306585762400_CIT0002","doi-asserted-by":"crossref","first-page":"6767","DOI":"10.1158\/1078-0432.CCR-05-0722","article-title":"Food and Drug Administration Drug approval summary: temozolomide plus radiation therapy for the treatment of newly diagnosed glioblastoma multiforme","volume":"11","author":"Cohen","year":"2005","journal-title":"Clin Cancer Res"},{"issue":"9","key":"2022100306585762400_CIT0003","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.4065\/82.9.1052","article-title":"Prophylaxis of pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and meta-analysis of randomized controlled trials","volume":"82","author":"Green","year":"2007","journal-title":"Mayo Clin Proc."},{"issue":"11","key":"2022100306585762400_CIT0004","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1200\/JOP.18.00366","article-title":"Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update summary","volume":"14","author":"Taplitz","year":"2018","journal-title":"J Oncol Pract."},{"key":"2022100306585762400_CIT0005","first-page":"48","author":"AA Pharma","year":"2019","journal-title":"Sulfatrim Product Monograph"},{"issue":"1","key":"2022100306585762400_CIT0006","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4065\/71.1.5","article-title":"Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illnesses and prior corticosteroid therapy","volume":"71","author":"Yale","year":"1996","journal-title":"Mayo Clin Proc."},{"issue":"3","key":"2022100306585762400_CIT0007","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.critrevonc.2012.08.002","article-title":"Pneumocystis jirovecii pneumonia prophylaxis during temozolomide treatment for high-grade gliomas","volume":"85","author":"De Vos","year":"2013","journal-title":"Crit Rev Oncol Hematol."},{"key":"2022100306585762400_CIT0008","doi-asserted-by":"crossref","first-page":"116431","DOI":"10.1016\/j.jns.2019.116431","article-title":"Lack of development of Pneumocystis jirovecii pneumonia in a cohort of 103 Italian glioblastoma patients not receiving prophylaxis during post-surgical chemoradiotherapy","volume":"405","author":"Rifino","year":"2019","journal-title":"J Neurol Sci."},{"issue":"4","key":"2022100306585762400_CIT0009","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2217\/cns.14.24","article-title":"Incidence of Pneumocystis jirovecii pneumonia after temozolomide for CNS malignancies without prophylaxis","volume":"3","author":"Neuwelt","year":"2014","journal-title":"CNS Oncol."},{"key":"2022100306585762400_CIT0010","volume-title":"Canadian Institute for Health Information Discharge Abstract Database: A Validation Study","author":"Juurlink","year":"2006"},{"key":"2022100306585762400_CIT0011","volume-title":"The ICES Practice Atlas: Patterns of Health Care in Ontario","author":"Goel","year":"1996"},{"issue":"5","key":"2022100306585762400_CIT0012","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/0895-4356(88)90052-2","article-title":"An application of capture-recapture methods to the estimation of completeness of cancer registration","volume":"41","author":"Robles","year":"1988","journal-title":"J Clin Epidemiol."},{"issue":"6","key":"2022100306585762400_CIT0013","doi-asserted-by":"crossref","first-page":"281","DOI":"10.3747\/co.21.2143","article-title":"Health system costs for stage-specific breast cancer: a population-based approach","volume":"21","author":"Mittmann","year":"2014","journal-title":"Curr Oncol"},{"issue":"18","key":"2022100306585762400_CIT0014","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1212\/WNL.0000000000012777","article-title":"Applying propensity score methods in clinical research in neurology","volume":"97","author":"Austin","year":"2021","journal-title":"Neurology"},{"key":"2022100306585762400_CIT0015","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2014"},{"key":"2022100306585762400_CIT0016","volume-title":"Package \u201cSurvey.\u201d","author":"Lumley","year":"2012"},{"issue":"5","key":"2022100306585762400_CIT0017","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1046\/J.1524-4733.2002.55150.x","article-title":"Odds ratio, relative risk, absolute risk reduction, and the number needed to treat\u2014which of these should we use?","volume":"5","author":"Schechtman","year":"2002","journal-title":"Value Health."},{"issue":"3","key":"2022100306585762400_CIT0018","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1023\/A:1024217527650","article-title":"Pneumocystis carinii pneumonia in HIV negative patients with primary brain tumors","volume":"63","author":"Mahindra","year":"2003","journal-title":"J Neurooncol."},{"key":"2022100306585762400_CIT0019","first-page":"48","author":"Merck Canada Inc","year":"2019","journal-title":"Temodal\u00ae Product Monograph: Consumer Information"},{"issue":"2","key":"2022100306585762400_CIT0020","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/ajco.12079","article-title":"Neuro-oncology practices in Australia: a Cooperative Group for Neuro-Oncology patterns of care study","volume":"10","author":"Chen","year":"2014","journal-title":"Asia Pac J Clin Oncol"},{"issue":"4","key":"2022100306585762400_CIT0021","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/nop\/npy049","article-title":"Pneumocystis jirovecii prophylaxis in patients treated for high-grade gliomas: a survey among neuro-oncologists","volume":"6","author":"Skorupan","year":"2019","journal-title":"Neuro-Oncol Pract."},{"key":"2022100306585762400_CIT0022","first-page":"vi65","article-title":"Choice of Pneumocystis jiroveci pneumonia prophylaxis does not increase hematologic toxicity of temozolomide and radiation in patients with glioblastoma","volume":"14","author":"Streeter","year":"2012","journal-title":"Neuro-Oncology"},{"issue":"5","key":"2022100306585762400_CIT0023","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.1164\/ajrccm.162.5.ed11-00a","article-title":"Pneumocystis carinii and Geographic Clustering","volume":"162","author":"Beck","year":"2000","journal-title":"Am J Respir Crit Care Med."},{"issue":"3","key":"2022100306585762400_CIT0024","first-page":"219","article-title":"Pneumocystis jirovecii pneumonia in developing countries","volume":"18","author":"De Armas Rodr\u00edguez","year":"2011","journal-title":"Parasite J Soci\u00e9t\u00e9 Fr Parasitol"}],"container-title":["Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/neuro-oncology\/advance-article-pdf\/doi\/10.1093\/neuonc\/noac072\/43387187\/noac072.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/neuro-oncology\/article-pdf\/24\/10\/1738\/46229376\/noac072.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/neuro-oncology\/article-pdf\/24\/10\/1738\/46229376\/noac072.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,3]],"date-time":"2022-10-03T06:59:32Z","timestamp":1664780372000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/neuro-oncology\/article\/24\/10\/1738\/6551567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,21]]},"references-count":24,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,3,21]]},"published-print":{"date-parts":[[2022,10,3]]}},"URL":"https:\/\/doi.org\/10.1093\/neuonc\/noac072","relation":{},"ISSN":["1522-8517","1523-5866"],"issn-type":[{"value":"1522-8517","type":"print"},{"value":"1523-5866","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,10,1]]},"published":{"date-parts":[[2022,3,21]]}}}