title: Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?
abstract: This study evaluated the correlation between the risk of febrile neutropenia (FN) estimated by physicians and the risk of severe neutropenia or FN predicted by a validated multivariate model in patients with nonmyeloid malignancies receiving chemotherapy. Before patient enrollment, physician and site characteristics were recorded, and physicians self-reported the FN risk at which they would typically consider granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (FN risk intervention threshold). For each patient, physicians electronically recorded their estimated FN risk, orders for G-CSF primary prophylaxis (yes/no), and patient characteristics for model predictions. Correlations between physician-assessed FN risk and model-predicted risk (primary endpoints) and between physician-assessed FN risk and G-CSF orders were calculated. Overall, 124 community-based oncologists registered; 944 patients initiating chemotherapy with intermediate FN risk enrolled. Median physician-assessed FN risk over all chemotherapy cycles was 20.0%, and median model-predicted risk was 17.9%; the correlation was 0.249 (95% CI, 0.179-0.316). The correlation between physician-assessed FN risk and subsequent orders for G-CSF primary prophylaxis (n = 634) was 0.313 (95% CI, 0.135-0.472). Among patients with a physician-assessed FN risk ≥ 20%, 14% did not receive G-CSF orders. G-CSF was not ordered for 16% of patients at or above their physician's self-reported FN risk intervention threshold (median, 20.0%) and was ordered for 21% below the threshold. Physician-assessed FN risk and model-predicted risk correlated weakly; however, there was moderate correlation between physician-assessed FN risk and orders for G-CSF primary prophylaxis. Further research and education on FN risk factors and appropriate G-CSF use are needed.
authors: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors: Gary H
authors: GH
authors: Lyman
authors: Department of Medicine, University of Washington, Seattle, Washington.
authors: David C
authors: DC
authors: Dale
authors: Global Biostatistical Science, Amgen Inc., Thousand Oaks, California.
authors: Jason C
authors: JC
authors: Legg
authors: Hematology/Oncology, Amgen Inc., Thousand Oaks, California.
authors: Esteban
authors: E
authors: Abella
authors: Hematology/Oncology, Amgen Inc., Thousand Oaks, California.
authors: Phuong Khanh
authors: PK
authors: Morrow
authors: Hematology/Oncology, Amgen Inc., Thousand Oaks, California.
authors: Sadie
authors: S
authors: Whittaker
authors: Department of Medicine, Duke University School of Medicine and Duke Cancer Institute, Durham, North Carolina.
authors: Jeffrey
authors: J
authors: Crawford
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D064147:Febrile Neutropenia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D010820:Physicians; D012306:Risk; D014481:United States; D055815:Young Adult
chemical_list: D016179:Granulocyte Colony-Stimulating Factor
keywords: Chemotherapy; febrile neutropenia; granulocyte colony-stimulating factor; neutropenia; primary prophylaxis; risk assessment; risk factors; risk model; severe neutropenia