title: Variation in the use of granulocyte-colony stimulating factor for dose dense paclitaxel: A single institution retrospective study.
abstract: BACKGROUND
  The necessity of using granulocyte-colony stimulating factor (G-CSF) during dose-dense (DD) paclitaxel (T) after doxorubicin and cyclophosphamide (AC) is unclear.
  
  
  METHODS
  This was a retrospective cohort study including patients with stage I-III breast cancer treated at Dana-Farber Cancer Institute with adjuvant DD-ACT between January 2011 and December 2013. Descriptive analyses evaluating patterns of G-CSF utilization during T were performed.
  
  
  RESULTS
  Overall, 156 patients were treated with DD-ACT by 26 providers. The majority of patients (135, 87%) received at least one dose of G-CSF during T (group 1), 17% of these patients received it in only one cycle and 48% received it in all four cycles. Reasons for omitting G-CSF included high baseline absolute neutrophil count and pain. Twenty-one (13%) patients did not receive any G-CSF during T (group 2). Respectively, 94% and 90% of patients completed the treatment in groups 1 and 2. There were no cases of treatment cessation due to neutropenia. Six percent of patients in group 1 had at least one treatment delay. There were no treatment delays reported in group 2. Variation in the use of G-CSF by provider and by patient was found, with 11 providers choosing not to use G-CSF in at least one patient.
  
  
  CONCLUSIONS
  We identified substantial variation in the use of G-CSF within the practice. However, omission of G-CSF was not associated with treatment delays or adverse events. Prospective studies are warranted to formally test whether routine G-CSF is necessary during dose-dense T therapy.
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Romualdo
authors.initials: R
authors.lastname: Barroso-Sousa
authors.affiliation: Oncoclinicas do Brasil, Rua Maranhão 569/4, São Paulo 01240-001, Brazil.
authors.forename: Flavia Rocha
authors.initials: FR
authors.lastname: Paes
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Ines
authors.initials: I
authors.lastname: Vaz-Luis
authors.affiliation: Oncoclinicas do Brasil, Rua Maranhão 569/4, São Paulo 01240-001, Brazil.
authors.forename: Rafael Borges
authors.initials: RB
authors.lastname: Batista
authors.affiliation: Oncoclinicas do Brasil, Rua Maranhão 569/4, São Paulo 01240-001, Brazil.
authors.forename: Rafael Brant
authors.initials: RB
authors.lastname: Costa
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Katya
authors.initials: K
authors.lastname: Losk
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Camuso
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Otto
authors.initials: O
authors.lastname: Metzger-Filho
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hughes
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Bunnell
authors.affiliation: Department of Surgery, Dana Farber/Brigham and Women's Cancer Center, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Mehra
authors.initials: M
authors.lastname: Golshan
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.affiliation: Department of Medical Oncology, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA. Electronic address: nancy_li@dfci.harvard.edu.
authors.forename: Nancy U
authors.initials: NU
authors.lastname: Lin
mesh_terms: D000328:Adult; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D016179:Granulocyte Colony-Stimulating Factor; D004317:Doxorubicin; D003520:Cyclophosphamide; D017239:Paclitaxel
keywords: Colony stimulating factors; Dose-dense chemotherapy; Paclitaxel