JL510. Febrile Neutropenia Risk Assessment Prior to Chemotherapy and Use of Colony-Stimulating Factor Prophylaxis in U.S. Community Oncology Clinics
Soeren Mattke, MD, MPH, DSc, RAND Health Advisory Services, RAND Corporation, Boston, Massachusetts, Elizabeth M. Sloss, PhD, RAND Corporation, Arlington, Virginia, Nabeel S. Qureshi, MPH, RAND Corporation, Boston, Massachusetts, Carol Roth, RN, MPH, RAND Corporation, Santa Monica, California, and Jonathan W. W. Goldman, MD, University of California Los Angeles, Los Angeles, California
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JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017
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Objective: Current guidelines recommend use of prophylactic colony-stimulating factor (CSF) prior to chemotherapy to prevent febrile neutropenia (FN) if the FN risk is greater than 20%. Use of CSF in lower-risk patients has been identified as low-value care in ASCO’s “Choosing Wisely” recommendations. Implementing those recommendations requires FN risk assessment because FN risk depends on the interplay of patient-level risk factors and the inherent toxicity of the regimen. We investigated the rate at which such risk assessment is documented outside of clinical trials and the implications for CSF use decisions.
Methods: We conducted retrospective chart review of 192 patients in five community oncology clinics in the U.S. prior to the first chemotherapy cycle to ascertain whether FN risk assessment was documented. We determined regimen risk based on published literature. Any documented reference to FN risk was categorized as having performed the risk assessment. Results: FN risk assessment was documented in 13% of patients across the five clinics with a range from 0% to 27%. The probability of FN risk assessment did not vary significantly by age, sex, race/ethnicity, and type of insurance coverage, but was significantly higher for chemotherapy regimens with an inherent risk of greater than 20% (21% vs. 7%, p < .01). 54% of patients (103/192) received CSF prophylaxis and patients were twice as likely to receive CSF if risk assessment was documented (96% vs. 48%, p < .01), even after accounting for regimen risk. 43% of patients (53/122) with low-risk regimens received CSF prophylaxis and 29% of patients (20/70) with high-risk regimens did not.
Conclusions: FN risk assessment to inform appropriate use of CSF prior to initiation of chemotherapy was infrequently documented in our sample of records from U.S. community oncology clinics. Failure to document FN risk may have contributed to both overuse and underuse of CSF prophylaxis.
Recommendations: Increased use of FN risk assessment prior to initiation of chemotherapy could help to improve safety of chemotherapy and avoid low-value utilization.
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