title: Pegfilgrastim use and bone pain: a cohort study of community-based cancer patients.
abstract: OBJECTIVE
  Bone pain is a common adverse effect of the granulocyte colony-stimulating factors filgrastim and pegfilgrastim. However, the incidence of reported bone pain varies and therapies to mitigate this adverse effect are limited to case reports and one randomized controlled trial. The purpose of this study was to describe pegfilgrastim use, the incidence and treatment of bone pain, and rate of severe or febrile neutropenia among cancer patients receiving pegfilgrastim at a metropolitan, hospital-based, community cancer center.
  
  
  METHODS
  This retrospective chart review included the first 100 adult oncology patients who received at least one dose of pegfilgrastim from 1 January 2012 to 31 December 2012. Descriptive analyses were used to evaluate the primary and secondary outcomes.
  
  
  RESULTS
  Of the identified cases, 69 cancer patients were evaluable. Most patients (74%) received pegfilgrastim for primary prophylaxis. Pegfilgrastim-associated bone pain occurred in 19% and loratadine was the most common medication used to treat it. Among the patients who received pegfilgrastim for primary prophylaxis, 8% were hospitalized for febrile neutropenia. Among those hospitalized for febrile neutropenia, 64% had not received pegfilgrastim for primary prophylaxis.
  
  
  CONCLUSIONS
  Pegfilgrastim is commonly used for primary prophylaxis during the first cycle of chemotherapy. Hospitalizations for febrile neutropenia occurred most commonly among patients without primary prophylaxis. Pegfilgrastim-associated bone pain occurred in a similar percentage, as reported in randomized controlled trials but less than that reported by survey. Loratadine was the most commonly employed medication to mitigate this adverse effect.
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN, USA Regions Hospital Cancer Care Center, St. Paul, MN, USA pamala.a.pawloski@healthpartners.com.
authors.forename: Pamala A
authors.initials: PA
authors.lastname: Pawloski
authors.affiliation: University of Minnesota College of Pharmacy, Minneapolis, MN, USA.
authors.forename: Mitch
authors.initials: M
authors.lastname: Larsen
authors.affiliation: United Hospital, St. Paul, MN, USA.
authors.forename: Assel
authors.initials: A
authors.lastname: Thoresen
authors.affiliation: Regions Hospital Cancer Care Center, St. Paul, MN, USA.
authors.forename: Monique D
authors.initials: MD
authors.lastname: Giordana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003151:Community Health Centers / Q000639:trends*; D005260:Female; D000069585:Filgrastim / Q000008:administration & dosage / Q000009:adverse effects*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D009503:Neutropenia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: C455861:pegfilgrastim; D011092:Polyethylene Glycols; D000069585:Filgrastim
keywords: Granulocyte colony-stimulating factor; antineoplastic combined chemotherapy protocols; neoplasms; neutropenia; pain