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Filgrastim use in patients receiving chemotherapy for early-stage breast cancer—a survey of physicians and patients

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Abstract

Purpose

Despite its widespread use as primary febrile neutropenia (FN) prophylaxis during chemotherapy for early-stage breast cancer, the optimal duration of daily filgrastim is unknown. Using the minimum effective duration may improve patient comfort and acceptability while reducing costs. Yet, suboptimal dosing may also negatively impact patient care. A survey was performed to obtain information regarding current practices for granulocyte colony-stimulating factor (G-CSF) use.

Methods

Canadian oncologists involved in the treatment of breast cancer patients, as well as patients who had received neo/adjuvant chemotherapy for breast cancer, were surveyed. Standardized surveys were designed to collect information on perceived reasons for G-CSF use and current practices.

Results

The surveys were completed by 38/50 (76%) physicians and 95/97 (98%) patients. For physicians, there was variability in the choice of chemotherapy regimens that required G-CSF support, the dose of filgrastim prescribed and the number of days prescribed. The majority of physicians reported using 5 (31.6%), 7 (47.4%), or 10 (13.2%) days of therapy. Nearly half of the patients (46.3%) recalled having experienced at least one of the chemotherapy-related complications including chemotherapy delays, dose reductions, and FN. While on filgrastim, 66.3% of patients reported myalgia and bone pain. Both physicians and patients expressed interest in participating in clinical trials designed to optimize the duration of filgrastim administration.

Conclusions

Significant variability in practice exists with respect to filgrastim administration. Definitive studies are therefore required to standardize and improve care, as this has the potential to impact treatment outcomes, patient quality of life, and cost savings.

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Acknowledgements

We are grateful to all the patients and physicians who completed this study.

Funding

Funding for this project was from local sources.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada

    John Hilton & Mark Clemons

  2. Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada

    John Hilton, Lisa Vandermeer, Marta Sienkiewicz, Sasha Mazzarello, Brian Hutton, Carol Stober, Dean Fergusson, A. Brianne Bota & Mark Clemons

  3. Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, Canada

    John Hilton

  4. Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada

    Brian Hutton & Dean Fergusson

  5. Department of Oncology, Division of Medical Oncology, London Regional Cancer Program, University of Western Ontario, London, Canada

    Phillip Blanchette

  6. Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada

    Anil A. Joy

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  1. John Hilton
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  2. Lisa Vandermeer
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  4. Sasha Mazzarello
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Correspondence to John Hilton.

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Conflicts of Interest

The authors declared that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Hilton, J., Vandermeer, L., Sienkiewicz, M. et al. Filgrastim use in patients receiving chemotherapy for early-stage breast cancer—a survey of physicians and patients. Support Care Cancer 26, 2323–2331 (2018). https://doi.org/10.1007/s00520-018-4074-8

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  • DOI: https://doi.org/10.1007/s00520-018-4074-8

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