July 2017 VOL 8, NO 7

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2017 NCCN Annual Conference

Noncompliance with G-CSF Guidelines Has Consequences

Noncompliance with G-CSF Guidelines Has ConsequencesCompliance with orders for granulocyte colony-stimulating factor (G-CSF) is suboptimal, and inadequate prophylaxis was directly tied to hospital admissions, according to results from a single-center retrospective study from the University of Pennsylvania Health System.

At the National Comprehensive Cancer Network 2017 Annual Conference, Julianne Hibbs, DO, of Pennsylvania Hospital, Philadelphia, described the use of G-CSF in 93 patients who developed febrile neutropenia (FN). She reported that 18% of this group should have received G-CSF but did not, and their average length of stay for FN was about 4 days longer than for patients who received these drugs appropriately.

“The length of stay for patients who did not receive G-CSF and met ASCO [American Society of Clinical Oncology] criteria was notably longer compared with the other subgroups,” she said. “These patients had extended hospital stays, which may represent more severe infections, greater morbidity, and higher healthcare costs.”

FN contributes significantly to the morbidity, mortality, and cost of caring for patients with cancer, but its incidence is reduced by the use of G-CSFs. Dr Hibbs and her team conducted the single-center retrospective study to evaluate oncologists’ compliance with ASCO guidelines for the appropriate use of G-CSF prophylaxis and to determine if noncompliance impacts the length of stay in patients developing FN.

Study of Patients with Febrile Neutropenia

The researchers identified 93 patients who developed FN as a direct complication of chemotherapy over a 2-year period. Based on ASCO guidelines for G-CSF use, they created 4 subgroups, which included patients who either (1) received G-CSF and met ASCO criteria (60%), (2) did not receive G-CSF although they met ASCO criteria (18%), (3) did not receive G-CSF and did not meet ASCO criteria (21%), or (4) received G-CSF but did not meet ASCO criteria (1%).

“We determined that compliance with G-CSF administration impacted length of hospital stay,” she reported. Mean length of stay for the above groups was: (1) 8.7 days, (2) 13.1 days, (3) 6.2 days, and (4) 9.2 days.

Risks from Chemotherapy Regimen and Personal Factors

Of the 16 patients who should have received G-CSF but did not, 8 met the criteria because they received chemotherapy regimens with >20% risk for FN. The other 8 received intermediate-risk (10%-20%) regimens but had at least 1 of 7 risk factors that warrant treatment (bone marrow involvement, persistent neutropenia, recent surgery or open wound, bilirubin >2 mg/dL, creatinine clearance <50%, age >65 years), Dr Hibbs noted.

“In our study, noncompliance with ASCO guidelines for prophylactic G-CSF use was seen equally in patients with high febrile neutropenia risk from their chemotherapy regimen and in patients with personal risk factors,” she said.

The differences among the groups were not statistically significant, she noted, “but this was thought to be secondary to the small patient population and lack of statistical power. The trend of the data demonstrates clinical relevance and warrants further investigation with a larger patient population.”

These results emphasize the need for effective risk stratification tools as well as adherence to G-CSF prophylaxis to improve patient outcomes, as directed by national and international guidelines, Dr Hibbs added. The researchers’ next step is to determine why compliance was not better.

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