Abstract
The purpose of the study is to describe oncologists’ perceptions and opinions about patient eligibility, guidelines, and barriers for use of granulocyte colony-stimulating factor (G-CSF), overall and stratified by their affiliation with the Oncology Care Model (OCM). In May 2018, we invited and recruited practicing US oncologists from a national database for an online survey. Level of agreement was identified using a seven-point scale, ranging from strongly disagree to strongly agree. Of 200 participating oncologists, 70 were OCM-affiliated. Overall, 65% of oncologists agreed or strongly agreed that all patients at high risk of febrile neutropenia (FN) should receive prophylactic G-CSF, and half agreed or strongly agreed that benefits of G-CSF outweigh the potential adverse effects. The most common barriers to G-CSF use for patients at high risk of FN included patient refusal (37.1% of OCM-affiliated oncologists vs. 21.5% of non-OCM-affiliated oncologists), not on protocol/not supported by guidelines (32.9% vs. 23.1%), lack of reimbursement to practice (30.0% vs. 15.4%), and concerns about insurance coverage (22.9% vs. 26.9%). More OCM-affiliated oncologists reported that their practices offer and strongly encourage adherence to a specific protocol for G-CSF use (49.2%) versus non-OCM oncologists (31.3%). Despite recommendations from national guidelines and strong evidence from randomized, controlled clinical trials, only two thirds of oncologists agree or strongly agree that all patients at high risk of FN should receive primary G-CSF prophylaxis. Decisions about G-CSF prophylaxis may be affected by factors other than risk of FN, such as patient choice, practice protocols/guidelines, lack of reimbursement, and insurance coverage.
Highlights
Febrile neutropenia (FN) following myelosuppressive chemotherapy is associated with significant morbidity, mortality, dose delays, and dose reductions [1,2,3]
Network (NCCN) [10], the Infectious Diseases Society of America (IDSA) [11], the American Society of Clinical Oncology (ASCO) [12], and the American Society of Hematology [13] all recommend granulocyte colony-stimulating factor (G-CSF) prophylaxis in patients receiving a chemotherapy regimen associated with a high risk of FN (≥ 20%)
Oncologists who consented completed a screening section prior to the actual survey so that their eligibility could be assessed according to the following criteria: (1) licensed and boardcertified in the USA in oncology and/or hematology for at least 3 years, (2) treated at least 40 unique oncology patients with chemotherapy in the past 6 months, (3) treated at least six oncology patients with a G-CSF in the past 6 months, (4) self or family member not affiliated with a marketing, pharmaceutical, or biotechnology company, and (5) proportion of professional time devoted to patient care ≥ 40% if affiliated with an academic center or ≥ 60% if affiliated with a community center
Summary
Febrile neutropenia (FN) following myelosuppressive chemotherapy is associated with significant morbidity, mortality, dose delays, and dose reductions [1,2,3]. Network (NCCN) [10], the Infectious Diseases Society of America (IDSA) [11], the American Society of Clinical Oncology (ASCO) [12], and the American Society of Hematology [13] all recommend G-CSF prophylaxis in patients receiving a chemotherapy regimen associated with a high risk of FN (≥ 20%). For patients receiving regimens associated with intermediate risk of FN (10–20%), the NCCN guidelines recommend considering G-CSF use if at least one patient-level risk factor is present [10]. G-CSF prophylaxis is observed in 17 to 74% of patients receiving chemotherapy regimens associated with high risk of FN, suggesting underutilization of an important preventive measure [14,15,16]. Neither is there evidence about the barriers that oncologists face when deciding to use G-CSF prophylaxis or their understanding of how patient-level risk factors modify FN risk
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