Abstract
Purpose
Primary prophylactic granulocyte colony-stimulating factors (PP-CSFs) are prescribed alongside chemotherapy regimens that carry a significant risk of febrile neutropenia (FN). As part of S1415CD, a prospective, pragmatic trial evaluating the impact of automated orders to improve PP-CSF prescribing, we evaluated patients’ baseline knowledge of PP-CSF and whether that knowledge improved following the first cycle of chemotherapy.
Methods
Adult patients with breast, colorectal, or non-small-cell lung cancer initiating chemotherapy were enrolled in S1415CD between January 2016 and April 2020. Eight questions assessing knowledge of CSF indications, risks, benefits, and out-of-pocket costs were included in a baseline survey and in a follow-up survey at the end of the first cycle of chemotherapy. Responses were stratified by the trial arm and whether chemotherapy was low, intermediate, or high FN risk.
Results
Of the 3605 eligible patients, 3580 (99.3%) completed the baseline survey, and 3420 (95.5%) completed the follow-up survey. At baseline, 803 (22.4%) patients responded “Don’t know” to all 8 questions, and all patients averaged 2.75 correct questions. At follow-up, knowledge increased by 0.34 in the high-FN-risk group (p < 0.001) but declined for the other FN-risk groups. In multivariate analysis, receiving a high-FN-risk regimen and younger age were significantly associated with knowledge improvement.
Conclusion
Chemotherapy patients had poor knowledge of PP-CSF that improved only modestly among recipients of high-FN-risk chemotherapy. Further efforts to inform patients about the risks, benefits, and costs of PP-CSF may be warranted, particularly for those in whom prophylaxis is indicated.
Trial registration: NCT02728596, April 6, 2016.
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Data availability
The National Cancer Institute’s (NCI) NCTN/NCORP Data Archives is a centralized, controlled-access database for sharing datasets generated from clinical trials of the National Clinical Trials Network (NCTN) and the NCI Community Oncology Research Program (NCORP). These datasets are made available on appropriate terms and conditions to researchers who wish to analyze the data in secondary studies to enhance the public health benefit of the original work. Requirements may include but are not limited to a research plan, a data use agreement (DUA), and legally binding signatures. Data will be available for request upon publication.
References
Swanson G, Bergstrom K, Stump E, Miyahara T, Herfindal ET (2000) Growth factor usage patterns and outcomes in the community setting: collection through a practice-based computerized clinical information system. J Clin Oncol 18(8):1764–1770. https://doi.org/10.1200/JCO.2000.18.8.1764
Alhifany AA, McAllister MW (2020) Assessment of granulocyte-colony stimulating factors use at a community-based teaching hospital and compliance with National Comprehensive Cancer Network guidelines. J Taibah Univ Med Sci 15(4):321–324. https://doi.org/10.1016/j.jtumed.2020.06.001
Bokemeyer C, Gascon P, Aapro M, Ludwig H, Boccadoro M, Denhaerynck K et al (2017) Over- and under-prophylaxis for chemotherapy-induced (febrile) neutropenia relative to evidence-based guidelines is associated with differences in outcomes: findings from the MONITOR-GCSF study. Support Care Cancer 25(6):1819–1828. https://doi.org/10.1007/s00520-017-3572-4
Ramsey SD, McCune JS, Blough DK, McDermott CL, Clarke L, Malin JL et al (2010) Colony-stimulating factor prescribing patterns in patients receiving chemotherapy for cancer. Am J Manag Care 16(9):678–686
Bansal A, Sullivan SD, Hershman DL, Lyman GH, Barlow WE, McCune JS et al (2017) A stakeholder-informed randomized, controlled comparative effectiveness study of an order prescribing intervention to improve colony stimulating factor use for cancer patients receiving myelosuppressive chemotherapy: the TrACER study. J Comp Eff Res 6(5):461–470. https://doi.org/10.2217/cer-2017-0005
Barger S, Sullivan SD, Bell-Brown A, Bott B, Ciccarella AM, Golenski J et al (2019) Effective stakeholder engagement: design and implementation of a clinical trial (SWOG S1415CD) to improve cancer care. BMC Med Res Methodol 19(1):119. https://doi.org/10.1186/s12874-019-0764-2
National Institutes of Health (2021) National Cancer Institute Community Oncology Research Program (NCORP). https://ncorp.cancer.gov/ Accessed 26 Oct 2021
Hershman DL, Bansal A, Sullivan SD, Lyman GH, Barlow WE, Arnold KB et al (2022) A pragmatic cluster-randomized trial of a standing physician order entry intervention for colony stimulating factor use among patients at intermediate risk for febrile neutropenia (SWOG S1415CD). J Clin Oncol 40(16_suppl):1518. https://doi.org/10.1200/JCO.2022.40.16_suppl.1518
Ramsey SD, Bansal A, Sullivan SD, Lyman GH, Barlow WE, Arnold KB et al (2022) A pragmatic cluster-randomized trial of a computerized clinical decision support system to improve colony stimulating factor prescribing for patients with cancer receiving myelosuppressive chemotherapy (SWOG S1415CD). J Clin Oncol 40(16_suppl):1525. https://doi.org/10.1200/JCO.2022.40.16_suppl.1525
Lively A, Minard LV, Scott S, Deal H, Lambourne T, Giffin J (2020) Exploring the perspectives of healthcare professionals in delivering optimal oncology medication education. PLoS One 15(2):e0228571. https://doi.org/10.1371/journal.pone.0228571
Tyson DM, Chavez MN, Lubrano B, Lake P, Gutierrez A, Marshall VK et al (2021) Understanding cancer survivors' educational needs about prescription opioid medications: implications for cancer education and health literacy. J Cancer Educ 36(2):215–224. https://doi.org/10.1007/s13187-021-01957-9
Neulasta Onpro (2019) Neulasta Onpro Commercial #2. USA: Youtube. Uploaded by ZandZ Mom, https://www.youtube.com/watch?v=Qv3BSnumcqg. Accessed 26 Oct 2021
Neulasta (2019) I'm Ready. USA: Youtube; 2006. p. 1:00. Uploaded by Affinity for the Impossible, https://www.youtube.com/watch?v=IB8wj5SX_f8. Accessed 26 Oct 2021
Amgen (2018) Neulasta Onpro TV Spot, 'Rather be home- Onpro'. https://www.ispot.tv/ad/wx59/neulasta-onpro-rather-be-home-onpro. Accessed 26 Oct 2021
Acknowledgements
We acknowledge and thank the members of the TrACER External Stakeholder Advisory Group for their extensive contributions to the science and conduct of this trial: Laurence Clark MD FACP, Jeffrey Crawford MD, David Decker MD FACP, Robert L. Erwin MS, John Golenski EdD, Mark Gorman, Judy Johnson MBA, Mike Kolodziej MD, Florence Kurttila MS, Jennifer Malin MD PhD, Ginny Mason RN, Anne Marie Mercurio, Jamie Myers PhD RN AOCNS® FAAN, William Petros PharmD FCCP, Elda Railey, Richard Schilsky MD FACP FASCO, Carole Seigel MBA, Barbara Segarra Vázquez DHSc, James Wade MD, Guneet Walia PhD, and Siu Fun Wong PharmD FASHP FCSHP.
Funding
This work was supported by a Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-1402–09988), the National Cancer Institute (grant numbers 5U10 CA180819-03, 5UG1CA189974), and the National Institutes of Health and National Cancer Institute Cancer Center Support Grant (P30 CA015704).
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G.L., A.B., S.S., K.A., W.B., D.H., and S.R. contributed to the study conception and design. G.L., A.B., S.S., K.A., W.B., D.H., T.L., and S.R. contributed to data collection and analysis. All authors read and approved the final manuscript.
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The TrACER trial was approved by institutional review boards at Fred Hutchinson Cancer Center in Seattle, WA (IR#8428) and at each of the 45 NCORP recruiting sites in the USA and Puerto Rico. A complete list of sites and their individual recruiting locations is available on ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/study/NCT02728596. All procedures performed were in accordance with the ethical standards of the approving institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
Competing Interests
Author S.R. reported having consulting or advisory roles with Bayer Corporation, GRAIL, Biovica, Flatiron Health, and Genentech and receiving research funding not related to this work from Genentech/Roche and Bayer Corporation. Author G.L. reported receiving research grants not related to this work from Amgen (to institution) and personal fees from Sandoz, G1 Therapeutics, Partners Healthcare, BeyondSpring, Squibb, Merck, Jazz Pharmaceuticals, Samsung, Seattle Genetics, and Fresenius outside the submitted work. Other authors report no other relevant financial or non-financial interests to disclose.
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Lyman, G.H., Bansal, A., Sullivan, S.D. et al. Impact of treatment experience on patient knowledge of colony-stimulating factors among patients receiving cancer chemotherapy: evidence from S1415CD—a large pragmatic trial. Support Care Cancer 31, 598 (2023). https://doi.org/10.1007/s00520-023-08056-z
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DOI: https://doi.org/10.1007/s00520-023-08056-z