Prophylaxis of chemotherapy-induced neutropenia: Patterns of care in U.S. community oncology practices

Abstract

9123 Background: Adherence to neutropenia guidelines may improve patient outcomes and decrease costs associated with febrile neutropenia (FN). This analysis presents baseline data on patterns of colony-stimulating factor (CSF) use among community-based oncology practices prior to an educational intervention targeted to health care providers to improve adherence to CSF guidelines from the National Oncology Alliance (NOA). Methods: Medical records were identified from 47 participating sites. Abstractors collected data from a sequential sample of adult cancer patients receiving chemotherapy during the year prior to site randomization to an educational intervention (June and August 2006). A complex algorithm was developed to identify patients for whom the NOA guidelines recommend primary prophylaxis with a CSF including (1) patients receiving a chemotherapy regimen with a >20% expected risk of FN and (2) patients receiving chemotherapy with a 10–20% risk of FN and who have one of the following risk factors present: diminished performance status or non-Hodgkin's lymphoma with low serum albumin or high serum LDH or spread to bone marrow. Results: 2594 patients were evaluated for this analysis. Most were female (66%) and the mean age was 61.7 years (± 13.1). During this period (2005–06), 423 (16%) patients received chemotherapy regimens with an FN risk >20% and 143 (6%) received chemotherapy regimens with an FN risk of 10–20% and had a risk factor. Of patients receiving chemotherapy with a >20% risk of FN, 176 (42%) received CSF primary prophylaxis. Of patients receiving chemotherapy with a 10–20% risk FN with a risk factor present, 40 (28%) received CSF primary prophylaxis. Conclusions: Many patients for whom guidelines recommend treatment did not receive CSF primary prophylaxis. After the year-long educational intervention, we will re-evaluate CSF patterns of care and assess whether adherence to guidelines improved patient outcomes. No significant financial relationships to disclose.