title: Granulocyte growth factor use in elderly patients with non-Hodgkin's lymphoma in the United States: adherence to guidelines and comparative effectiveness.
abstract: The efficacy of prophylactic granulocyte colony-stimulating factors (G-CSFs) among elderly patients with non-Hodgkin's lymphoma (NHL) receiving CHOP-based chemotherapy has been demonstrated in clinical trials, and G-CSFs are recommended in guidelines. We studied guideline adherence and the effectiveness of G-CSFs in the general population.
  
  
  
  We used inpatient and outpatient claims from nationally representative databases linked to cancer information from tumor registries. Patients (N = 5884) diagnosed with NHL between 2001 and 2007 who were older than 65 years and who received CHOP-based chemotherapy were included. Adherence to guidelines was measured as the use of G-CSFs within 7 days of the first dose of chemotherapy. The measures of effectiveness were fever, infection, and death during cycle 1 of chemotherapy and time to cycle 2. Multiple-variable models of these outcomes were developed using logistic regression, controlling for demographic, clinical, and provider factors.
  
  
  
  G-CSF use increased from 32 % in 2001 to 72 % in 2007. Patients who received G-CSFs were significantly less likely to have outpatient encounters for infection than those who did not receive early G-CSFs (35 vs 47 %; p < 0.0001). Inpatient encounters for infection were similarly prevalent among patients who did or did not receive early G-CSFs (5 vs 4 %; p = 0.2). There was no association between G-CSF use and death during cycle 1.
  
  
  
  Adherence to guidelines increased after publication of clinical trials and exceeded 70 % after publication of guidelines. G-CSFs were effective in preventing outpatient encounters for fever or infection, but not inpatient encounters or deaths during cycle 1.
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA. lelting@mdanderson.org.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA.
authors.forename: Mariana
authors.initials: M
authors.lastname: Chavez-MacGregor
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1444, Houston, TX, 77030, USA.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D064147:Febrile Neutropenia / Q000188:drug therapy*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D011239:Prednisolone / Q000009:adverse effects; D014481:United States; D014750:Vincristine / Q000009:adverse effects
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone
keywords: Febrile neutropenia; Granulocyte growth factors; Guideline adherence; SEER-Medicare