Temporal and Geographic Variation in the Use of Hematopoietic Growth Factors in Older Women Receiving Breast Cancer Chemotherapy: Findings From a Large Population-Based Cohort

Du, Xianglin L.; Lairson, David R.; Begley, Charles E.; Fang, Shenying

doi:10.1200/jco.2005.02.6252

Cited by 31 publications

(22 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous population studies expressed concern about counter-intuitive findings in factors associated with CSF administration, e.g., older women with higher co-morbidity indices had lower probability of receiving CSF. Studies also found that more severe tumor characteristics were associated with higher probability of PP-CSF administration [24,25]. In this study, initial univariate comparisons did indicate similar associations in age and clinical characteristics, though these associations resolved to statistical insignificance after more specified multivariate analysis.…”

Section: Discussionsupporting

confidence: 53%

“…Regional disparities in the administration of PP-CSF are substantial. Past studies have also shown significant regional variations [24,25]. Local coverage differences due to possible differences in ''Local Medical Review Policies'' (LMRPs) of the regional Medicare contractors might lead to differences in regional prescribing patterns [47][48][49].…”

Section: Discussionmentioning

confidence: 99%

“…As a result of this lack of clarity, many physicians still consider ''watchful waiting'' to be a viable option during the first course chemotherapy [22,23]. Past studies have established that absence of specific guidelines for CSF administration, especially in the older patients, has led to unexplained geographic and racial, and counter-intuitive clinical variations in CSF administration [24,25]. For example older individuals with higher co-morbidities have lower probability of CSF receipt, in spite if their higher risk of neutropenia.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Chemotherapy characteristics are important predictors of primary prophylactic CSF administration in older patients with breast cancer

Rajan

Lyman

Carpenter

et al. 2010

Breast Cancer Res Treat

View full text Add to dashboard Cite

Chemotherapy is vital for breast cancer management, but early onset toxicities like neutropenia hinder its administration. Primary prophylactic (PP) use of colony- stimulating factors (CSF) helps prevent neutropenia and ensures successful chemotherapy completion. Nevertheless, lack of specific guidelines for CSF administration in older patients has lead to unexplained geographic and racial, and counter-intuitive clinical variations in CSF administration. This study examined the reasons for these variations and for the first time looked at variations in PP-CSF administration and duration of administration in breast cancer patients receiving chemotherapy. This retrospective observational study of newly diagnosed breast cancer patients receiving chemotherapy used SEER-Medicare data from 1994-2003. Regression analyses were used to explore the factors associated with PP-CSF administration and duration of administration. Clinical and therapeutic characteristics previously unexplored by other studies were included. Univariate analyses demonstrated geographic, racial and clinical disparities similar to previous studies. However, clinical correlations resolved to statistical insignificance after inclusion of chemotherapy characteristics. The analysis showed that significant geographic and racial disparities existed. History of recent antibiotic use was associated with shorter PP-CSF administration. Physicians' decision to administer PP-CSF is predominantly driven by neutropenia risk associated with pre-planned chemotherapy regimen. Older, sicker women at a higher risk of neutropenia receive less intense/toxic chemotherapy and thus do not require PP-CSF. Geographic variations are driven by proportion of physicians administering PP-CSF with no evidence for overuse among specific physicians. Association of recent antibiotic use with shorter PP-CSF administration suggests intended substitution of the expensive PP-CSF with prophylactic antibiotics.

show abstract

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Chemotherapy characteristics are important predictors of primary prophylactic CSF administration in older patients with breast cancer

Rajan

Lyman

Carpenter

et al. 2010

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…16,19 A recent population-based study in older breast cancer patients reported substantial regional variation in filgrastim use. 23 Likewise, prior studies have found substantial variation in physicians' self-reported use of CSFs for prophylaxis of FN. 24 Additionally, prescribing patterns (i.e., the timing of initiation and duration of use) for filgrastim have been shown to vary from that used in the clinical trials in several community practice studies.…”

Section: What This Study Addsmentioning

confidence: 99%

Observational Study of the Prevalence of Febrile Neutropenia in Patients Who Received Filgrastim or Pegfilgrastim Associated With 3-4 Week Chemotherapy Regimens in Community Oncology Practices

Morrison

Wong

Hershman

et al. 2007

JMCP

103

View full text Add to dashboard Cite

FoRMuLARy MAnAgeMenTsingle injection was required. In these patients treated with a heterogeneous group of chemotherapy regimens with a broad range of risk of FN, overall, an absolute 1.8% increase in the incidence of developing FN was observed in patients who received filgrastim compared with patients who received pegfilgrastim, (absolute rates of 6.5% and 4.7%, respectively). What is already known about this subject• Chemotherapy-induced neutropenia is a common side effect of cancer treatment, which leaves patients vulnerable to lifethreatening infections. The risk of febrile neutropenia (FN) can vary depending on chemotherapy drug regimens and patient characteristics such as advanced age or comorbid conditions (i.e., poor renal function, diabetes). • Randomized controlled trials have shown colony-stimulating factors (CSFs) filgrastim and pegfilgrastim significantly decrease the risk of FN by half (risk reduction [RR], 0.54 in randomized controlled trials). The absolute RR reported in the clinical trials ranged from 8% to 37%, the variation reflecting differences in the base-line risk of FN associated with the chemotherapy regimen.• Head-to-head randomized controlled trials of pegfilgrastim versus filgrastim demonstrate that both drugs have similar efficacy; however, little is known about their relative effectiveness in clinical practice. What this study adds• For the first time, data are available regarding the real-world incidence of FN in chemotherapy patients treated in the community setting with filgrastim or pegfilgrastim or both CSF agents.• In community oncology practices, patients who received filgrastim initiated treatment later and received fewer days per cycle than the timing of initiation and duration of therapy demonstrated to be effective in randomized controlled trials. In contrast, pegfilgrastim was commonly initiated within 3 days of chemotherapy.• Among patients treated with a heterogeneous group of chemotherapy regimens with a broad range of risk of FN in community oncology practices, overall, a 1.8% overall increase in the incidence of developing FN was observed in patients who received filgrastim compared with patients who received pegfilgrastim (absolute rates of 6.5% and 4.7%, respectively) resulting in a 40% increase in the odds of FN. For every 56 patients treated in community settings with pegfilgrastim instead of filgrastim, 1 additional case of FN would be avoided.BACKGROUNd: Colony-stimulating factors (CSFs) significantly decrease the risk of febrile neutropenia (FN), a common complication of myelosuppressive chemotherapy. Pegfilgrastim (6 mg), introduced in 2002, has a sustained duration of action, with a single dose comparable in efficacy to daily injections of filgrastim (5 μg per kg per day) for 10 to 11 days; both agents should be initiated 24 hours after completing chemotherapy.

show abstract

“…Three categories of variables were controlled for namelypatient socio-demographic, clinical (overall and tumorrelated), and therapeutic characteristics [10,32,34,[42][43][44][45]. Table 1 describes each characteristic and the corresponding variable.…”

Section: Potential Confounding Variablesmentioning

confidence: 99%

Effect of primary prophylactic G-CSF use on systemic therapy administration for elderly breast cancer patients

Rajan

Stearns

Lyman

et al. 2011

Breast Cancer Res Treat

View full text Add to dashboard Cite

Effective systemic therapy is vital for successful breast cancer treatment, but early onset toxicities like neutropenia hinder systemic therapy administration, especially in the elderly. Primary prophylactic use of granulocyte-colony stimulating factors (G-CSF) helps prevent neutropenia, and according to some clinical trials, facilitates chemotherapy completion. Nevertheless, evidence supporting the effectiveness of primary prophylactic G-CSF in the elderly is limited. Thus, the ASCO recommendations for primary prophylactic G-CSF use in the elderly are not explicit. This retrospective observational study examined the association between primary prophylactic G-CSF administration at the start of first course chemotherapy with adequate first course chemotherapy and radiation therapy administration in elderly breast cancer patients. The study analyzes newly diagnosed breast cancer patients receiving chemotherapy present in the SEER-Medicare data from 1994 to 2003. To account for the non-random nature of the observational data, a non-parametric matching technique was used to pre-process the data before estimating the effect of primary prophylactic G-CSF on adequate chemotherapy and radiation therapy administration. Adequate chemotherapy was defined as administration of six or more cycles during the first course. Primary prophylactic G-CSF administered at the start of the first course chemotherapy was associated with a statistically significant increase in the probability of administration of six or more first course chemotherapy cycles by 29% [95% CI 7.7-50.6%] and any radiation therapy administration by 42% [95% CI 25.2-58.4%]. Primary prophylactic G-CSF use with the first course of chemotherapy is associated with improved chemotherapy completion rates and radiation therapy. These findings emphasize the clinical value of primary prophylactic G-CSF use for systemic therapy completion, and have implications for ASCO guidelines and medicare coverage policies.

show abstract

Temporal and Geographic Variation in the Use of Hematopoietic Growth Factors in Older Women Receiving Breast Cancer Chemotherapy: Findings From a Large Population-Based Cohort

Cited by 31 publications

References 45 publications

Chemotherapy characteristics are important predictors of primary prophylactic CSF administration in older patients with breast cancer

Chemotherapy characteristics are important predictors of primary prophylactic CSF administration in older patients with breast cancer

Observational Study of the Prevalence of Febrile Neutropenia in Patients Who Received Filgrastim or Pegfilgrastim Associated With 3-4 Week Chemotherapy Regimens in Community Oncology Practices

Effect of primary prophylactic G-CSF use on systemic therapy administration for elderly breast cancer patients

Contact Info

Product

Resources

About