title: The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin's lymphoma.
abstract: BACKGROUND
  The use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting.
  
  
  METHODS
  Nine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged <65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period.
  
  
  RESULTS
  The most frequently used regimens in breast cancer patients (n = 161) were FEC (45%), FEC-T (37%) and docetaxel alone (6%). In NHL patients (n = 39), R-CHOP-21 (33%) and R-ACVBP-14 (15%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31% of breast cancer patients, and 13% had PSN. After G-CSF secondary prophylaxis (SP), 4% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20%) developed FN, whereas 13 (45%) of the 29 patients without PP developed FN and 3 (10%) PSN. Overall, 55% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40% (breast cancer) and 38% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48% (4.2 days) and 19% (1.5 days). Similar rates were obtained from hematologists.
  
  
  CONCLUSIONS
  Despite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.
authors.affiliation: Health Economics and Outcomes Research Department, IMS Health Consulting, Medialaan 38, 1800 Vilvoorde, Belgium. LGerlier@be.imshealth.com
authors.forename: Laetitia
authors.initials: L
authors.lastname: Gerlier
authors.forename: Mark
authors.initials: M
authors.lastname: Lamotte
authors.forename: Ahmad
authors.initials: A
authors.lastname: Awada
authors.forename: André
authors.initials: A
authors.lastname: Bosly
authors.forename: Greet
authors.initials: G
authors.lastname: Bries
authors.forename: Véronique
authors.initials: V
authors.lastname: Cocquyt
authors.forename: Christian
authors.initials: C
authors.lastname: Focan
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Henry
authors.forename: Yassine
authors.initials: Y
authors.lastname: Lalami
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Machiels
authors.forename: Jeroen
authors.initials: J
authors.lastname: Mebis
authors.forename: Nicole
authors.initials: N
authors.lastname: Straetmans
authors.forename: Didier
authors.initials: D
authors.lastname: Verhoeven
authors.forename: Luc
authors.initials: L
authors.lastname: Somers
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001530:Belgium / Q000453:epidemiology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019983:Guideline Adherence; D019538:Health Care Surveys; D006760:Hospitalization; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016179:Granulocyte Colony-Stimulating Factor