title: Reducing febrile neutropenia rates in early breast cancer. Experience of two UK cancer centres.
abstract: OBJECTIVE
  Primary prophylaxis with granulocyte colony-stimulating factor (G-CSF) is used in many institutions across the UK due to unacceptable febrile neutropenia (FN) rates with FEC-D (fluorouracil, epirubicin, cyclophosphamide-docetaxel). The resultant reduction in FN rate is thought to maintain dose intensity and improve patient experience. This retrospective study was performed to assess whether the addition of G-CSF primary prophylaxis into daily clinical practice has achieved these aims.
  
  
  METHODS
  Collaborative audit performed in two UK cancer centres before and after the integration of G-CSF primary prophylaxis with FEC-D. The primary objective was FN rate.
  
  
  RESULTS
  Data from 342 patients were analysed, 151 before routine use of primary G-CSF and 191 after. The FN rates were 30 and 11%, respectively. Despite the 99% adherence to primary G-CSF policy, there were more dose reductions (8 increased to 13%) and dose delays (11 increased to 23%) following the use of G-CSF primary prophylaxis. This appeared to be due to non-FN toxicities. Inpatient days decreased substantially from 93 to 16 and antibiotic courses from 28 to 13 (per hundred patients).
  
  
  CONCLUSIONS
  Near universal adherence to the G-CSF policy in FEC-D treatment has led to a reduction in FN rate and inpatient days but has not translated into improved dose intensity. This collaborative audit allows sufficient data to give insight into current practice and generate hypotheses for further investigation.
authors.affiliation: Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, Merseyside, CH63 4JY, UK, anna.mullard@wales.nhs.uk.
authors.forename: A P
authors.initials: AP
authors.lastname: Mullard
authors.forename: V
authors.initials: V
authors.lastname: Misra
authors.forename: P
authors.initials: P
authors.lastname: Sumra
authors.forename: Z
authors.initials: Z
authors.lastname: Ali
authors.forename: S M
authors.initials: SM
authors.lastname: O'Reilly
authors.forename: Z
authors.initials: Z
authors.lastname: Malik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology / Q000517:prevention & control*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D043823:Taxoids; D016179:Granulocyte Colony-Stimulating Factor; D000077143:Docetaxel; D015251:Epirubicin; D003520:Cyclophosphamide; D005472:Fluorouracil