Improving prophylactic growth factor (pGCSF) use in non-small cell lung cancer (NSCLC) patients (pts) receiving chemotherapy (CT) at the Cleveland Clinic Taussig Cancer Institute (TCI).

Abstract

83 Background: Per guidelines (ASCO, NCCN, EORTC), pGCSF is not recommended for pts receiving CT regimens with low risk (< 10%) for febrile neutropenia (FN). Inappropriate use of pGCSF increases pt morbidity and healthcare costs. In the current healthcare environment, it is critical to maximize value via alignment with accepted care standards and elimination of unnecessary costs. Methods: A multidisciplinary team was created to perform a quality improvement (QI) project under ASCO’s Quality Training Program. We reviewed all NSCLC pts at TCI who initiated a new CT regimen from April to November 2013. First-cycle pGCSF use was identified and deemed appropriate if prescribed for CT associated with high risk of FN (>20%) or intermediate risk (10-20%) if other risk factors for FN were present (age, gender, performance status, renal/hepatic function, prior treatment with radiation or CT, and pre-existing neutropenia, wounds, or infection). Use with low-risk CT was recorded as inappropriate. Results: 179 NSCLC pts received a new CT regimen during the specified time period. 22/90 pts (24%) treated with low-risk CT received pGCSF. Each pt received an average of 3 doses with 69 total doses administered. In all other instances pGCSF was prescribed in accordance with guidelines. Using QI strategies, we identified and implemented three PDSA cycles: education of NSCLC providers, development of TCI Consensus Guidelines for the use of pGCSF in NSCLC, and removal of standing pGCSF orders from low-risk CT regimens in the EMR. Cost analysis shows the potential to save 1.6 million dollars in charges over 1 year when pGCSF is not administered to NSCLC pts receiving low risk CT. Conclusions: pGCSF was excessively prescribed for NSCLC pts at a tertiary care academic medical center. Factors contributing to inappropriate pGCSF use included providers’ lack of familiarity with guidelines and the risk of FN for CT regimens as well as EMR CT templates with standing pGCSF. Appropriate pGCSF administration leads to significant cost savings without adverse impact on pt outcomes. Re-measurement is in progress and will be presented at the time of the meeting.