Risk assessment of febrile neutropenia and evaluation of G-CSF use in patients with cancer: a real-life study

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The guidelines suggest using granulocyte-colony stimulating factor (G-CSF) for febrile neutropenia (FN) as prophylaxis in chemotherapy protocols with the risk of 10–20% after assessment of patient’s risk factors. Therefore, the aim of this study is to assess the risk of FN by using the Patient Risk Score (PRS) and evaluating G-CSF use and its side effects by a clinical pharmacist at an outpatient clinic.


The study was conducted from May 2017 until November 2017 at the University Hospital oncology outpatient clinic. Patients who receive chemotherapy protocols with FN risk of 10–20% and > 20% and were initiated G-CSF were included. The patients’ risk factors were assessed by the PRS, and the side effects were monitored for 3 months by a clinical pharmacist via a patient self-reported monitoring card.


A total of 118 patients were included (286 interviews) in the study. There was a significant increase between the first and third visits on the PRS total scores of patients (p = 0.034). The patterns of G-CSF use showed that 34.7% undertreated, 22.8% overtreated, and 42.3% of patients were correctly treated for the prophylaxis. The severity of G-CSF-related musculoskeletal pain was increased on the second and third days of treatment.


The use of G-CSFs for FN prophylaxis is recommended; however, there may be a group of patients who are inadequately or unnecessarily treated. Therefore, patients should be assessed for the risk of developing FN in each cycle of chemotherapy and a regular risk assessment by using the PRS can be implemented in the monitoring process.

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Correspondence to Aygin Bayraktar-Ekincioglu.

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The study was approved by the Hacettepe University Clinical Trials Ethics Committee.

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The authors declare that they have no conflict of interest.

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Aras, E., Bayraktar-Ekincioglu, A. & Kilickap, S. Risk assessment of febrile neutropenia and evaluation of G-CSF use in patients with cancer: a real-life study. Support Care Cancer 28, 691–699 (2020).

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  • G-CSF
  • Clinical pharmacist
  • Side effect
  • Febrile neutropenia
  • Risk
  • Prophylaxis