Time trends in utilization of G-CSF prophylaxis and risk of febrile neutropenia in a Medicare population receiving adjuvant chemotherapy for early-stage breast cancer

Rk, Goyal; Tzivelekis, Spiros; Rothman, Kenneth J.; Candrilli, Sean; Kaye, James A.

doi:10.1007/s00520-017-3863-9

Cited by 12 publications

(11 citation statements)

References 32 publications

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“…In their study, prophylactic G-CSF use among patients receiving intermediate FN risk chemotherapy was 10% for breast cancer and 20% for lung cancer patients. The relatively higher use of prophylactic G-CSF among patients receiving high FN risk chemotherapy observed in our study and in the study by Sosa and colleagues compared to the older study by Ramsey et al is a reflection of the gradual increase in use of prophylactic G-CSF since 2002, primarily due to the introduction of pegfilgrastim [26]. pegfilgrastim users who could not be classified as pegfilgrastim PFS or OBI.…”

Section: Discussioncontrasting

confidence: 48%

Patterns of granulocyte colony–stimulating factor prophylaxis in patients with cancer receiving myelosuppressive chemotherapy

Gawade

Henry

et al. 2020

Support Care Cancer

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Purpose To evaluate patterns of primary prophylactic (PP) granulocyte colony-stimulating factor (G-CSF) use following chemotherapy by cancer type and febrile neutropenia (FN) risk. Methods Using a commercial administrative database, we identified adult patients diagnosed with breast, colorectal, lung, ovarian cancer, or non-Hodgkin lymphoma (NHL) who initiated chemotherapy with high risk (HR) or intermediate risk (IR) for FN between January 1, 2013, and August 31, 2017. We describe use of PP-G-CSF, proportion completing all their cycles with pegfilgrastim, timing of pegfilgrastim, and duration of short-acting G-CSF. Results Among 22,868 patients (breast 11,513; colorectal 3765; lung 4273; ovarian 1287; and NHL 2030), 36.8% received HR and 63.2% received IR (64.4% of whom had ≥ 1 risk factor [RF] for FN). Proportions of patients receiving PP-G-CSF in the first cycle were 76.1%, 28.2%, and 26.4% among patients receiving HR, IR, and IR plus ≥ 1 RF, respectively. Among breast cancer patients receiving HR regimens and initiating PP-pegfilgrastim, 60.4% (95% confidence interval [CI] 57.2-63.6%) initiating via on-body injector (OBI) and 51.9% (95% CI 48.0-55.8%) initiating via prefilled syringe (PFS) completed all their cycles with OBI and PFS, respectively. Among all cycles with PP-PFS, 8.5% received PFS on the same day as chemotherapy completion. Mean administrations/cycle were 3.2 (standard deviation [SD] 2.3) for filgrastim, 3.0 (SD 1.6) for filgrastim-sndz, and 4.3 (SD 2.5) for tbo-filgrastim. Conclusions There is under-and mistimed use of PP-G-CSF among patients at HR for FN. Novel pegfilgrastim delivery devices could help breast cancer patients at HR for FN complete all their cycles with timely prophylaxis.

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Section: Discussioncontrasting

confidence: 48%

Patterns of granulocyte colony–stimulating factor prophylaxis in patients with cancer receiving myelosuppressive chemotherapy

Gawade

Henry

et al. 2020

Support Care Cancer

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“…(2.5% vs. 4.6%). 18 This is likely the result of younger cancer patients in this study compared to the Medicare enrollees evaluated by Goyal et al. A sensitivity analysis evaluating the changes in NRH occurrence by restricting to the first five positions in the diagnosis claims revealed similar temporal trends.…”

Section: Discussionmentioning

confidence: 63%

“…It is difficult to relate results from this study with published literature because prior studies have focused on specific regimens, 17 regimens with high risk for FN, 18 any chemotherapy, 24 or elderly Medicare enrollees. 15 In their study using four health insurance databases from 2002 to 2005 (Medicare, Medicaid, and 2 commercial), Ramsey 15 The increase in use of CSF observed in this study aligns with findings from previous publications.…”

Section: Discussionmentioning

confidence: 99%

Trends in use of primary prophylactic colony stimulating factors and neutropenia-related hospitalization in commercially insured patients receiving myelosuppressive chemotherapy in the United States: 2005–2017

Schenfeld

Bennett

et al. 2020

J Oncol Pharm Pract

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Purpose Describe temporal changes in use of myelosuppressive chemotherapy, primary prophylactic colony-stimulating factor, and neutropenia-related hospitalization, in commercially insured patients. Methods Using a large commercial administrative database, we identified annual cohorts of adult patients diagnosed with breast or lung cancer, or non-Hodgkin lymphoma and initiating myelosuppressive chemotherapy during 2005–2017. We described yearly changes in proportions of myelosuppressive chemotherapy by febrile neutropenia risk category (high, intermediate, unclassified) and proportion of prophylactic colony-stimulating factor use and unadjusted incidence of neutropenia-related hospitalization in the first cycle of myelosuppressive chemotherapy. Results Annual cohorts included 4383–5888 eligible patients during 2005–2017. The proportion of eligible patients aged ≥ 65 years increased from 26.0% in 2005 to 58.2% in 2017. Myelosuppressive chemotherapy use with regimens with high risk for febrile neutropenia increased from 15.1% in 2005 to 31.0% in 2017; and regimens with intermediate risk for febrile neutropenia decreased from 63.7% to 48.1% in 2017. Prophylactic colony-stimulating factor use increased from 41.6% in 2005 to 54.3% in 2017. Crude incidence of neutropenia-related hospitalization for all cancers increased from 2.0% to 3.1%, with a substantial increase in neutropenia-related hospitalization observed among non-Hodgkin lymphoma patients (2.8% to 8.5%) during 2005–2017. Conclusion Among adult patients with breast and lung cancer, and non-Hodgkin lymphoma receiving myelosuppressive chemotherapy, use of regimens with high risk for febrile neutropenia increased, as did the use of prophylactic colony-stimulating factors after 2005. Incidence of neutropenia-related hospitalization increased slightly, particularly among non-Hodgkin lymphoma patients. Further studies are required to understand this increasing trend of neutropenia-related hospitalization, changing patient-level risk factors, and febrile neutropenia management.

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“…Dessa forma, além de aumentar os custos, essa toxicidade hematológica afeta diretamente a eficácia do tratamento e a qualidade de vida do paciente. Goyal et al 23 descrevem que a neutropenia febril ocorre em 3% a 24% dos pacientes com câncer de mama em estágio inicial que recebem quimioterapia 23 .…”

Section: Discussionunclassified

“…Em dois deles, foi empregado juntamente com o regime FEC, apresentando neutropenia em apenas 4,47% dos casos. Porém, quando associado à carboplatina e ao trastuzumabe, ocorreu neutropenia em 83% das pacientes [22][23][24] .…”

Section: Métodounclassified

Neutropenia Associada ao Tratamento do Câncer de Mama: Revisão Integrativa da Literatura

Conte

Sgnaolin

2019

Rev. Brasileira.De.Cancerologia

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Introdução: O câncer de mama é a neoplasia mais frequente entre as mulheres e como alternativa para o seu tratamento são utilizados medicamentos quimioterápicos. A neutropenia é a toxicidade hematológica mais séria induzida pelo tratamento quimioterápico. Objetivo: Avaliar, por revisão bibliográfica, a ocorrência de neutropenia em pacientes com câncer de mama, a partir de estudos que abordam diferentes regimes de tratamento quimioterápicos. Método: Revisão integrativa da literatura. Foram coletados dados nas três bases de dados PubMed, Periódicos Capes e LILACS. Os termos utilizados foram neutropenia, breast cancer, chemotherapy e toxicity hematological. Os artigos selecionados foram publicados entre 2013 a 2018. Um total de 101 artigos inicialmente avaliados e 23 selecionados. Para análise dos dados, foram extraídas as informações sobre o número de pacientes incluídas no estudo, a idade e a ocorrência de neutropenia, número total e frequência. Resultados: No total, 19.528 mulheres realizaram tratamento quimioterápico e foram incluídas na pesquisa. Dos 13 medicamentos quimioterápicos relatados nos estudos selecionados, os regimes mais utilizados foram epirrubicina, fluorouracil, ciclofosfamida e docetaxel (FEC-D), docetaxel e ciclofosfamida (TC) e doxorrubicina, ciclofosfamida e docetaxel (AC-T). Todos os regimes terapêuticos estudados causaram neutropenia grau 3 ou 4 como toxicidade hematológica. Em nove estudos, a neutropenia foi superior a 50%. Conclusão: A neutropenia apresenta elevada ocorrência, independente do tratamento quimioterápico utilizado para o tratamento do câncer de mama. Os esquemas mais associados foram platina/taxano e ciclofosfamida/antraciclinas/taxanos, que são os mais frequentemente utilizados por sua elevada eficácia.

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Time trends in utilization of G-CSF prophylaxis and risk of febrile neutropenia in a Medicare population receiving adjuvant chemotherapy for early-stage breast cancer

Abstract: The use of G-CSF PP increased substantially during the study period. Although channeling of higher-risk patients to treatment with G-CSF PP is expected, the adjusted risk of FN among patients treated with G-CSF PP tended to be lower than among those not receiving G-CSF PP.

Cited by 12 publications

References 32 publications

Patterns of granulocyte colony–stimulating factor prophylaxis in patients with cancer receiving myelosuppressive chemotherapy

Patterns of granulocyte colony–stimulating factor prophylaxis in patients with cancer receiving myelosuppressive chemotherapy

Trends in use of primary prophylactic colony stimulating factors and neutropenia-related hospitalization in commercially insured patients receiving myelosuppressive chemotherapy in the United States: 2005–2017

Neutropenia Associada ao Tratamento do Câncer de Mama: Revisão Integrativa da Literatura

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