Adherence to granulocyte-colony stimulating factor (G-CSF) guidelines to reduce the incidence of febrile neutropenia after chemotherapy—a representative sample survey in Germany

Link, Hartmut; Nietsch, J.; Kerkmann, Markus; Ortner, Petra

doi:10.1007/s00520-015-2779-5

Cited by 32 publications

(34 citation statements)

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“…Both in pure osteoprotective therapy and taking into account recommended calcium and vitamin D supplements, the results in lung cancer are worse than in breast cancer and prostate cancer. This is in line with the results of studies on the adherence to G-CSF prophylaxis GL [14,19]. In patients with breast or prostate carcinoma, the adherence to guidelines for osteoprotection is significantly higher, even if the absolute figures can still be significantly improved when analyzed according to strict standards.…”

Section: Discussionsupporting

confidence: 83%

“…The methods and analysis of this study have already been successfully applied and published in comparable studies of AGSMO (formerly ASORS) for neutropenia prophylaxis with G-CSF after chemotherapy [14,19]. Further details are published in the supplementary material.…”

Section: Methodsmentioning

confidence: 99%

“…In order to analyze the possible correlations between treatment in accordance with the guidelines and the competence profile of the treating physicians, the data of the patient documentation and the practitioner survey were correlated and analyzed using a Classification and Regression Tree (CART). CART is a tree-building binary recursive partitioning method that uses the Gini index for discrete distributions [17,18]; for details, see earlier publication [14]. The following data from the physician survey are included in the evaluation: age of the treating physician; academic title; specialist medical training; training place and duration of training in oncology and in drug tumor therapy; position in the department/ practice; activity in study groups; publications in specialist journals and textbooks; active cooperation in guidelines; scientific focus; participation in regional, national, and international congresses; and participation in training courses.…”

Section: Statistical Testsmentioning

confidence: 99%

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Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany

Diel

Ohlmann

Holtmann³

et al. 2019

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Purpose To assess adherence to the current European Society for Medical Oncology (ESMO) clinical practice guideline on bone health in cancer patients and the German guidelines for lung, breast, and prostate cancer among German oncologists in hospitals and office-based physicians and to identify predictors of guideline compliance to assess the needs for dedicated training. Methods This was a retrospective sample analysis representing hospitals and office-based physicians in Germany in 2016. Records from lung, breast, and prostate cancer patients who had received a diagnosis of bone metastasis between April 1, 2015, and March 31, 2016, were included. Oncologists at participating centers answered a self-assessment survey on aspects related to their professional life, including guideline adherence and years of clinical experience in medical oncology. Guideline adherence rates were assessed from patient records. Treatment variables and survey data were used to identify predictors of guideline compliance in a Classification and Regression Tree (CART) analysis. Results Disregarding recommendations for supplementation of calcium and vitamin D, guideline adherence among physicians treating lung, breast, or prostate cancer patients was 62%, 92%, and 83%, respectively. Compliance was 15%, 42%, and 40% if recommendations for dietary supplements were taken into account. Identified predictors of guideline compliance included treatment setting, medical specialty, years of professional experience, and frequency of quality circle attendance. Conclusions Compliance with the ESMO and the German guidelines in cancer patients varies between medical specialties. In particular, patients with lung cancer and bone metastases often do not receive the recommended osteoprotective treatment and required supplementation. Discrepancies between guideline recommendations and common practice should be addressed with dedicated training.

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Statistical Testsmentioning

confidence: 99%

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Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany

Diel

Ohlmann

Holtmann³

et al. 2019

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“…Patient adherence with the filgrastim regimen is another potentially salient reason for under-dosing. Lack of physician familiarity or awareness of the G-CSF guidelines and/or the consequences of FN on RDI and, thereby, cancer survival is likely to be another factor behind under-dosing of filgrastim and under use of G-CSF in general [39][40][41]. In Germany, for example, despite 85.1% of 195 physicians stating that they followed G-CSF guidelines, evidence revealed only 15.4% adherence for high-risk lung cancer patients and < 50% for intermediaterisk lung and breast cancer patients [41].…”

Section: Pegfilgrastim Versus Filgrastimmentioning

confidence: 99%

“…Lack of physician familiarity or awareness of the G-CSF guidelines and/or the consequences of FN on RDI and, thereby, cancer survival is likely to be another factor behind under-dosing of filgrastim and under use of G-CSF in general [39][40][41]. In Germany, for example, despite 85.1% of 195 physicians stating that they followed G-CSF guidelines, evidence revealed only 15.4% adherence for high-risk lung cancer patients and < 50% for intermediaterisk lung and breast cancer patients [41]. Lack of risk factors was cited by over half the physicians as a reason for not using G-CSF in patients prescribed a chemotherapy with a FN risk ≥ 20% [41], yet the assessment of risk factors in this group of patients is unnecessary and only required for intermediate-or low-risk groups [1,5,16].…”

Section: Pegfilgrastim Versus Filgrastimmentioning

confidence: 99%

Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure

et al. 2020

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Febrile neutropenia (FN) is a serious complication of chemotherapy, which can cause significant morbidity and mortality, result in dose delays and reductions and, ultimately, reduce cancer survival. Over the past decade, the availability of biosimilar filgrastim (short-acting granulocyte colony-stimulating factor [G-CSF]) has transformed patient access, with clear evidence of clinical benefit at preventing FN at reduced costs. In 2019, seven biosimilar pegfilgrastims (long-acting G-CSFs) were licensed, creating optimal market conditions and choice for prescribers. FN affects up to 117 per 1000 cancer patients, with mortality rates in the range of 2-21%. By reducing FN incidence and improving chemotherapy relative dose intensity (RDI), G-CSF has been associated with a 3.2% absolute survival benefit. Guidelines recommend primary prophylaxis and that filgrastim be administered for 10-14 days, while pegfilgrastim is administered once per cycle. When taken according to the guidelines, pegfilgrastim and filgrastim are equally effective. However, in routine clinical practice, filgrastim is often under-dosed (< 7 days) and has been shown to be inferior to pegfilgrastim at reducing FN incidence, hospitalisations and maintaining RDI. Once-per-cycle administration with pegfilgrastim might also aid patient adherence. The introduction of biosimilar pegfilgrastim should instigate a rethink of neutropenia management. Biosimilar pegfilgrastim offers countries using biosimilar filgrastim opportunities to improve adherence and thus cancer survival, whilst offering economic benefits for countries using reference pegfilgrastim. These benefits can be realised in full if biosimilar pegfilgrastim becomes part of routine clinical practice supported by drug and therapeutic committees implementing guidelines with multidisciplinary support in the hospital.

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Qualitätssicherung zur Therapie des muskelinvasiven und metastasierten Harnblasenkarzinoms in Deutschland

Ohlmann

Kerkmann²,

Holtmann³

et al. 2022

Urologie

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Hintergrund Die S3-Leitlinie zum Harnblasenkarzinom empfiehlt eine radikale Zystektomie und eine Cisplatin-basierte perioperative Chemotherapie (POC) bei Patienten mit muskelinvasivem Harnblasenkarzinom (MIBC). Für metastasierte Urothelkarzinome (mUC) wird eine Cisplatin-basierte oder immunonkologische (IO) Behandlung bei Patienten, die für eine Platintherapie (Pt) nicht in Frage kommen, oder als Zweitlinientherapie empfohlen. Ziel der Studie Ziel der Studie war es, repräsentative Daten zur klinischen Routinebehandlung von MIBC und mUC in Deutschland zu erhalten. Material und Methoden Es wurde eine bundesweite Umfrage durchgeführt, um stadienbezogene Daten zum Patientenaufkommen in Krankenhäusern und bei niedergelassenen Ärzten zu erhalten. Basierend auf diesen Ergebnissen wurde eine repräsentative Stichprobe von Behandlungsdaten von Patienten mit MIBC und mUC retrospektiv erhoben. Ergebnisse Es wurden Daten von 956 Patienten (MIBC: 576; mUC: 380) gesammelt. Von den MIBC-Patienten erhielten 49,8 % eine systemische Therapie (80,4 % von ihnen Cisplatin/Gemcitabin) und 50,2 % wurden mit einer Zystektomie ohne POC behandelt. Signifikante Faktoren für eine Zystektomie ohne POC waren ein höheres Alter > 75 Jahre (Odds ratio [OR] 4,91, 95 % CI 3,01‑8,11, p < 0,001), Cisplatin-ungeeignete Patienten (OR 2,15, 95 % CI 1,30‑3,59; p = 0,003) und die fehlende Beratung in einem interdisziplinären Tumorboard (OR 2,43, 95 % CI 1,65‑3,61, p < 0,001). Bei mUC erhalten Pt-vorbehandelte Patienten am ehesten eine IO-Therapie (OR 12,07, 95 % CI 6,94-21,82, p < 0,001). Weitere Faktoren sind ein positiver PD-L1-Status (OR 3,72, 95 % CI 1,30‑5,71, p < 0,001), ein höheres Alter > 75 Jahre (OR 2,83, 95 % CI 1,43‑5,73, p = 0,003) und Pt-Eignung (OR 2,57, 95 %CI 1,30‑5,71, p = 0,007). Schlussfolgerungen Der „Goldstandard“ Cisplatin/Gemcitabin ist in Deutschland etabliert, wenn Patienten mit POC behandelt werden. Dennoch erhielt die Hälfte der MIBC-Patienten keine POC, insbesondere wenn die Behandlungsentscheidung nicht in einem Tumorboard diskutiert wird. Beim mUC ist die IO-Therapie als Zweitlinientherapie nach einer Pt-basierten Behandlung etabliert. Obwohl die Leitlinienempfehlungen weitgehend umgesetzt sind, besteht Optimierungspotenzial, insbesondere bei der Etablierung von interdisziplinären Tumorboards.

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Adherence to granulocyte-colony stimulating factor (G-CSF) guidelines to reduce the incidence of febrile neutropenia after chemotherapy—a representative sample survey in Germany

Abstract: Acceptance of and adherence to G-CSF GL differed between lung cancer, lymphoma, and breast cancer. Physicians overestimate their adherence to the GL. Physicians adhering to the GL can be characterized.

Cited by 32 publications

References 38 publications

Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany

Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany

Biosimilar Pegfilgrastim: Improving Access and Optimising Practice to Supportive Care that Enables Cure

Qualitätssicherung zur Therapie des muskelinvasiven und metastasierten Harnblasenkarzinoms in Deutschland

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