Attitudes of physicians toward assessing risk and using granulocyte colony-stimulating factor as primary prophylaxis in patients receiving chemotherapy associated with an intermediate risk of febrile neutropenia
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Febrile neutropenia (FN) is a potentially fatal complication of chemotherapy. This prospective, observational study describes physicians’ approaches toward assessing FN risk in patients receiving chemotherapy regimens with an intermediate (10–20 %) FN risk. In the baseline investigator assessment, physicians selected factors considered important when assessing overall FN risk and deciding on granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (PP). Physicians then completed patient assessments using the same lists of factors. The final FN risk scores and whether G-CSF PP was planned were reported. The final analysis included 165 physicians and 944 patients. The most frequently considered factor in both assessments was chemotherapy agents in the backbone (88 % of investigator and 93 % of patient assessments). History of FN (83 %), baseline laboratory values (76 %) and age (73 %) were commonly selected at baseline, whereas tumor type (72 %), guidelines (62 %) and tumor stage (43 %) were selected most during patient assessments. Median investigator-reported FN risk threshold for G-CSF PP was 20 % (range 10–85 %). G-CSF PP was planned in 82 % of patients with an FN risk at or above this threshold; therefore, almost one-fifth of qualifying patients would not receive G-CSF PP. Physicians generally follow guidelines, but also consider individual patient characteristics when assessing FN risk and deciding on G-CSF PP. A standardized FN risk assessment may optimize the use of G-CSF PP, which may minimize the incidence of FN in patients undergoing chemotherapy with an intermediate FN risk. ClinicalTrials.gov Identifier: NCT01813721.
KeywordsFebrile neutropenia Chemotherapy Granulocyte colony-stimulating factor G-CSF Prophylaxis Risk factors
This study was sponsored by Amgen. We thank all patients, physicians, coordinators and other staff who participated in the study. Medical writing support was provided by Elizabeth Hartfield (Ph.D.) from Oxford PharmaGenesis, Oxford, UK. Funding for this support was provided by Amgen (Europe) GmbH.
Compliance with ethical standards
Conflicts of interest
Gilles Freyer, Giuseppe Tonini, Konstantinos Syrigos, Zee Wan Wong, Say Liang Ng and Antonio Salar have declared no conflicts of interest. Ewa Kalinka-Warzocha has received honoraria from Amgen and Teva. Mihai Marinca has received honoraria from Amgen and Sandoz. Guenther Steger has received honoraria from and has participated in advisory board meetings for Amgen and Teva. Mahmood Abdelsalam has received consultancy fees from Sanofi and honoraria from Eli Lilly and Johnson & Johnson. He has also received travel grants from Amgen, Roche and Astellas and has participated in advisory board meetings for Amgen, Janssen and Innomar Strategies. Lucy DeCosta and Zsolt Szabo are employees and shareholders of Amgen.
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