title: Health care use and primary prophylaxis with colony-stimulating factors.
abstract: OBJECTIVE
  We examined health care use in conjunction with primary prophylaxis use of colony stimulating factors (CSF) during patients' initial course of chemotherapy.
  
  
  METHODS
  This retrospective cohort study identified adults aged 25 years and older with a diagnosis of breast, colorectal, or nonsmall cell lung cancer between 2002 and 2005 from the Western Washington Surveillance Epidemiology and End Results Puget Sound registry. We linked these records to health insurance claims from four payers representing 75% of those insured in the state. Claims records were used to determine chemotherapy regimen type, CSF use, febrile neutropenia occurrences, and supportive care. Chemotherapy regimens were categorized as conferring high, intermediate, or low risk of myelosuppression according to the National Comprehensive Cancer Network guidelines. CSF use was described as primary prophylaxis, other, or none. Antibiotics and antifungal and antiviral agents per National Comprehensive Cancer Network guidelines for supportive care for cancer infection were categorized using Healthcare Common Procedure Coding System and National Drug Code assignments.
  
  
  RESULTS
  Use of CSF as primary prophylaxis is not significantly associated with a reduction in antibiotic use or inpatient or outpatient visits. Primary prophylactic CSF use was associated with less use of antiviral drugs.
  
  
  CONCLUSIONS
  CSF use is not associated with a reduction in health care use, with the exception of antiviral drug use. Given the expense associated with CSF use, pragmatic trials and additional research are needed to further assess the affects of CSF on health care use.
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.forename: David K
authors.initials: DK
authors.lastname: Blough
authors.forename: Cara L
authors.initials: CL
authors.lastname: McDermott
authors.forename: Lauren
authors.initials: L
authors.lastname: Clarke
authors.forename: Jeannine S
authors.initials: JS
authors.lastname: McCune
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003115:Colony-Stimulating Factors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000382:microbiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018426:SEER Program; D014861:Washington
chemical_list: D000970:Antineoplastic Agents; D003115:Colony-Stimulating Factors