Abstract
Data on real-life utilization of granulocyte colony-stimulating factors (g-csfs) in Canada are limited. The objective of the present study was to describe the reasons for, and the patterns of, g-csf use in selected outpatient oncology clinics in Ontario and Quebec. In a retrospective longitudinal cohort study, a review of medical records from 9 Canadian oncology clinics identified patients being prescribed filgrastim (fil) and pegfilgrastim (peg). Patient characteristics, reasons for g-csf use, and treatment patterns were descriptively analyzed. Medical records of 395 patients initiating g-csf therapy between January 2008 and January 2009 were included. Of this population, 80% were women, and breast cancer was the predominant diagnosis (59%). The most commonly prescribed g-csf was fil (56% in Ontario and 98% in Quebec). The most frequent reason for g-csf use was primary prophylaxis (42% for both fil and peg), followed by secondary prophylaxis (37% fil, 41% peg). Those proportions varied by tumour type and chemotherapy regimen. Delayed g-csf administration (more than 1 day after the end of chemotherapy) was frequently observed for fil, but rarely reported for peg, and that finding was consistent across tumours and concurrent chemotherapy regimens. The use of g-csf varies with the malignancy type and the provincial health care setting. The most commonly prescribed g-csf agent was fil, and most first g-csf prescriptions were for primary prophylaxis. Delays were frequently observed for patients receiving fil, but were rarely reported for those receiving peg.
Highlights
The most commonly prescribed g-csf agent was fil, and most first g-csf prescriptions were for primary prophylaxis
Febrile neutropenia is the most serious consequence of neutropenia, and it can be associated with high medical costs, early mortality, and lengthy hospitalization, which can result in dose reductions or delays in the administration of the cycle of chemotherapy[1,2,3,4,5]
Several clinical and observational studies have demonstrated that, for patients with severe and Current Oncology—Volume 21, Number 2, April 2014 e229 prolonged neutropenia or fn, efficacy is better with primary prophylaxis than with reactive strategies[12,13,14,15,16]
Summary
Febrile neutropenia (fn) is the most serious consequence of neutropenia, and it can be associated with high medical costs, early mortality, and lengthy hospitalization, which can result in dose reductions or delays in the administration of the cycle of chemotherapy[1,2,3,4,5]. International guidelines from the American Society of Clinical Oncology, the European Organization for Research and Treatment of Cancer (eortc), the U.S National Comprehensive Cancer Network, and Cancer Care Ontario[6,7,8,9] recommend prophylactic use of recombinant human granulocyte colony–stimulating factor (g-csf) such as filgrastim (fil) and pegfilgrastim (peg) for adult patients with solid tumours and nonmyeloid malignancies undergoing chemotherapy when the overall risk of fn is approximately 20% or greater. Other factors taken into consideration include patient age, especially for those more than 65 years of age; prior history of chemotherapy or radiotherapy, or both; poor performance status (Eastern Cooperative Oncology Group score of 3–4); poor renal function; and liver dysfunction Both fil and peg are indicated to lower the risk of fever and infection with myelosuppressive chemotherapies in nonmyeloid malignancies[10,11]. The objective of the present study was to describe the reasons for, and the patterns of, g-csf use in selected outpatient oncology clinics in Ontario and Quebec
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