"Same-Day" administration of pegfilgrastim following myelosuppressive chemotherapy: clinical practice and provider rationale.

Abstract

To describe patient- and practice-related factors that physicians report affect their clinical decision to administer prophylactic pegfilgrastim to patients <24h after completion of a myelosuppressive chemotherapy cycle (i.e., "same-day" pegfilgrastim). Oncologists, hematologists, and hematologist-oncologists enrolled in a US national physician panel were invited to participate in a cross-sectional, web-based survey to assess physicians' reasons for prescribing "same-day" pegfilgrastim. Physicians were screened as eligible if they reported prescribing "same-day" pegfilgrastim within the previous 6months. The survey assessed physician perspectives and physician-perceived patient/caregiver preferences. Of 17,478 invited physicians, 386 answered the screening questions; 151 (39.1%) were eligible, agreed to participate, and completed the survey. Physicians estimated that overall 41.3% of their patients treated with myelosuppressive chemotherapy received pegfilgrastim and that 31.6% treated with pegfilgrastim received it on a "same-day" schedule. Approximately 36% of physicians relied primarily on their clinical judgment when deciding to administer "same-day" pegfilgrastim. The clinical consideration reported most commonly by physicians as moderately or very important when deciding to administer "same-day" pegfilgrastim was previous febrile neutropenia (77.6%). The most important patient-related consideration in the decision to administer "same-day" pegfilgrastim was patient/caregiver travel distance, and the most important practice-related consideration was the burden to the physician's practice of "next-day" administration (vs. same-day), reported by 84.7 % and 65.1% of physicians as moderately or very important, respectively. While clinical judgment, patients' risk factors, and practice burden were principal influences favoring "same-day" pegfilgrastim administration, physician-perceived patient preferences and logistical barriers also have important roles in this decision.