G‐CSF utilization rate and prescribing patterns in <scp>United States</scp>: associations between physician and patient factors and GCSF use

Barnes, Gisoo; Pathak, Ashutosh; Schwartzberg, Lee

doi:10.1002/cam4.344

Cited by 55 publications

(46 citation statements)

References 47 publications

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“…Another study found that G-CSFs was being over utilized in patients undergoing chemotherapy associated with low risk of FN and underutilized in patients with high risk of FN. This finding is similar to ours, whereby G-CSFs were underutilized in patients with high risk of FN [17][18][19][20][21][22][23][24][25]. However, G-CSFs were prescribed appropriately in intermediate-and low-risk patients at our institution.…”

Section: Discussionsupporting

confidence: 89%

Evaluation of the Use of Granulocyte Colony-Stimulating Factors (G-CSFs) for Neutropenia Primary Prophylaxis in Solid Tumors at a Tertiary Care Hospital, Retrospective Study

Af¹,

Alnatsheh²,

Aseeri³

et al. 2017

J Pharmacovigil

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Section: Discussionsupporting

confidence: 89%

Evaluation of the Use of Granulocyte Colony-Stimulating Factors (G-CSFs) for Neutropenia Primary Prophylaxis in Solid Tumors at a Tertiary Care Hospital, Retrospective Study

Af¹,

Alnatsheh²,

Aseeri³

et al. 2017

J Pharmacovigil

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“…Patient adherence with the filgrastim regimen is another potentially salient reason for under-dosing. Lack of physician familiarity or awareness of the G-CSF guidelines and/or the consequences of FN on RDI and, thereby, cancer survival is likely to be another factor behind under-dosing of filgrastim and under use of G-CSF in general [39][40][41]. In Germany, for example, despite 85.1% of 195 physicians stating that they followed G-CSF guidelines, evidence revealed only 15.4% adherence for high-risk lung cancer patients and < 50% for intermediaterisk lung and breast cancer patients [41].…”

Section: Pegfilgrastim Versus Filgrastimmentioning

confidence: 99%

“…Lack of risk factors was cited by over half the physicians as a reason for not using G-CSF in patients prescribed a chemotherapy with a FN risk ≥ 20% [41], yet the assessment of risk factors in this group of patients is unnecessary and only required for intermediate-or low-risk groups [1,5,16]. Overall, it has been reported that as many as 80% of patients do not receive primary prophylaxis with G-CSF in accordance with their assessed risk [39,41]. Dose reductions of chemotherapy related to neutropenia and use of G-CSF only as secondary prophylaxis have also been found to be widespread in clinical practice [39,41].…”

Section: Pegfilgrastim Versus Filgrastimmentioning

confidence: 99%

“…Overall, it has been reported that as many as 80% of patients do not receive primary prophylaxis with G-CSF in accordance with their assessed risk [39,41]. Dose reductions of chemotherapy related to neutropenia and use of G-CSF only as secondary prophylaxis have also been found to be widespread in clinical practice [39,41]. This widespread reporting of under-dosing (by weightadapted dose and duration of therapy), with lack of adherence to both prescribing guidelines and the approved drug label for G-CSF, is striking.…”

Section: Pegfilgrastim Versus Filgrastimmentioning

confidence: 99%

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Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure

et al. 2020

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Febrile neutropenia (FN) is a serious complication of chemotherapy, which can cause significant morbidity and mortality, result in dose delays and reductions and, ultimately, reduce cancer survival. Over the past decade, the availability of biosimilar filgrastim (short-acting granulocyte colony-stimulating factor [G-CSF]) has transformed patient access, with clear evidence of clinical benefit at preventing FN at reduced costs. In 2019, seven biosimilar pegfilgrastims (long-acting G-CSFs) were licensed, creating optimal market conditions and choice for prescribers. FN affects up to 117 per 1000 cancer patients, with mortality rates in the range of 2-21%. By reducing FN incidence and improving chemotherapy relative dose intensity (RDI), G-CSF has been associated with a 3.2% absolute survival benefit. Guidelines recommend primary prophylaxis and that filgrastim be administered for 10-14 days, while pegfilgrastim is administered once per cycle. When taken according to the guidelines, pegfilgrastim and filgrastim are equally effective. However, in routine clinical practice, filgrastim is often under-dosed (< 7 days) and has been shown to be inferior to pegfilgrastim at reducing FN incidence, hospitalisations and maintaining RDI. Once-per-cycle administration with pegfilgrastim might also aid patient adherence. The introduction of biosimilar pegfilgrastim should instigate a rethink of neutropenia management. Biosimilar pegfilgrastim offers countries using biosimilar filgrastim opportunities to improve adherence and thus cancer survival, whilst offering economic benefits for countries using reference pegfilgrastim. These benefits can be realised in full if biosimilar pegfilgrastim becomes part of routine clinical practice supported by drug and therapeutic committees implementing guidelines with multidisciplinary support in the hospital.

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“…The survey questionnaire was developed using standard survey methodology [22]. Before online implementation, a draft survey questionnaire was reviewed in two pilot tests.…”

Section: Survey Developmentmentioning

confidence: 99%

A Survey of Oncologists’ Perceptions and Opinions Regarding the Use of Granulocyte Colony-Stimulating Factors

et al. 2019

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The purpose of the study is to describe oncologists' perceptions and opinions about patient eligibility, guidelines, and barriers for use of granulocyte colony-stimulating factor (G-CSF), overall and stratified by their affiliation with the Oncology Care Model (OCM). In May 2018, we invited and recruited practicing US oncologists from a national database for an online survey. Level of agreement was identified using a seven-point scale, ranging from strongly disagree to strongly agree. Of 200 participating oncologists, 70 were OCM-affiliated. Overall, 65% of oncologists agreed or strongly agreed that all patients at high risk of febrile neutropenia (FN) should receive prophylactic G-CSF, and half agreed or strongly agreed that benefits of G-CSF outweigh the potential adverse effects. The most common barriers to G-CSF use for patients at high risk of FN included patient refusal (37.1% of OCM-affiliated oncologists vs. 21.5% of non-OCM-affiliated oncologists), not on protocol/not supported by guidelines (32.9% vs. 23.1%), lack of reimbursement to practice (30.0% vs. 15.4%), and concerns about insurance coverage (22.9% vs. 26.9%). More OCM-affiliated oncologists reported that their practices offer and strongly encourage adherence to a specific protocol for G-CSF use (49.2%) versus non-OCM oncologists (31.3%). Despite recommendations from national guidelines and strong evidence from randomized, controlled clinical trials, only two thirds of oncologists agree or strongly agree that all patients at high risk of FN should receive primary G-CSF prophylaxis. Decisions about G-CSF prophylaxis may be affected by factors other than risk of FN, such as patient choice, practice protocols/guidelines, lack of reimbursement, and insurance coverage.

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G‐CSF utilization rate and prescribing patterns in United States: associations between physician and patient factors and GCSF use

Cited by 55 publications

References 47 publications

Evaluation of the Use of Granulocyte Colony-Stimulating Factors (G-CSFs) for Neutropenia Primary Prophylaxis in Solid Tumors at a Tertiary Care Hospital, Retrospective Study

Evaluation of the Use of Granulocyte Colony-Stimulating Factors (G-CSFs) for Neutropenia Primary Prophylaxis in Solid Tumors at a Tertiary Care Hospital, Retrospective Study

Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure

A Survey of Oncologists’ Perceptions and Opinions Regarding the Use of Granulocyte Colony-Stimulating Factors

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