title: Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy--findings from clinical practice.
abstract: OBJECTIVE
  Clinical practice adherence to current guidelines that recommend primary prophylaxis (PP) with granulocyte colony-stimulating factors (G-CSFs) for patients at high (≥20 %) overall risk of febrile neutropenia (FN) was evaluated.
  
  
  METHODS
  Adult patients with breast cancer, non-small cell lung cancer (NSCLC), small-cell lung cancer (SCLC), or ovarian cancer were enrolled if myelotoxic chemotherapy was planned, and they had an investigator-assessed overall FN risk ≥20 %. The primary outcome was FN incidence.
  
  
  RESULTS
  In total, 1,347 patients were analysed (breast cancer, n = 829; NSCLC, n = 224; SCLC, n = 137; ovarian cancer, n = 157). Patients with breast cancer exhibited fewer individual FN risk factors than patients with other cancers and were far more likely to have received a high-FN-risk chemotherapy regimen. However, a substantial proportion of all patients (45-80 % across tumour types) did not receive G-CSF PP in alignment with investigator risk assessment and guideline recommendations. FN occurred in 127 patients overall (9 %, 95% confidence interval (CI) 8-11 %), and incidence was higher in SCLC (15 %) than other tumour types (8 % in ovarian and NSCLC, 9 % in breast cancer). A post hoc analysis of G-CSF use indicated that G-CSF prophylaxis was not given within the recommended timeframe after chemotherapy (within 1-3 days) or was not continued across all cycles in 39 % of patients.
  
  
  CONCLUSIONS
  FN risk assessment was predominantly based on clinical judgement and individual risk factors, and guidelines regarding G-CSF PP for patients at high FN risk were not consistently followed. Improved education of physicians may enable more fully informed neutropenia management in patients with solid tumours.
authors.affiliation: Oncology Department, University Hospital, Sniadeckich 10, Krakow, 31-531, Poland, krzemieniecki@plusnet.pl.
authors.forename: K
authors.initials: K
authors.lastname: Krzemieniecki
authors.forename: P
authors.initials: P
authors.lastname: Sevelda
authors.forename: F
authors.initials: F
authors.lastname: Erdkamp
authors.forename: M
authors.initials: M
authors.lastname: Smakal
authors.forename: M
authors.initials: M
authors.lastname: Schwenkglenks
authors.forename: J
authors.initials: J
authors.lastname: Puertas
authors.forename: A
authors.initials: A
authors.lastname: Trojan
authors.forename: Z
authors.initials: Z
authors.lastname: Szabo
authors.forename: K
authors.initials: K
authors.lastname: Bendall
authors.forename: J
authors.initials: J
authors.lastname: Maenpaa
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor