Febrile neutropenia prophylaxis, G-CSF physician preferences: discrete-choice experiment

Abstract

ObjectivesFebrile neutropenia (FN) commonly occurs during cancer chemotherapy. Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is known to reduce the severity and incidence of FN and infections in patients with cancer. Despite the proven efficacy, G-CSFs are not always prescribed as recommended. We performed a discrete-choice experiment (DCE) to determine what factors drive the physician preference for FN prophylaxis in patients with cancer undergoing chemotherapy.MethodsAttributes for the DCE were selected based on literature search and on expert focus group discussions and comprised pain at the injection site, presence of bone pain, associated fever/influenza syndrome, efficacy of prophylaxis, biosimilar availability, number of injections per chemotherapy cycle and cost. Oncologists, in a national database, were solicited to participate in an online DCE. The study collected the responses to the choice scenarios, the oncologist characteristics and their usual prescriptions of G-CSFs in the context of breast, lungs and gastrointestinal cancers.ResultsOverall, the responses from 205 physicians were analysed. The physicians were mainly male (61%), with ≤20 years of experience (76%) and working only in public hospitals (73%). The physicians prescribe G-CSF primary prophylaxis for 32% of patients: filgrastim in 46% and pegfilgrastim in 54%. The choice of G-CSF for primary and secondary prophylaxis was driven by cost and number of injections. Biosimilars were well accepted.ConclusionCost and convenience of G-CSF drive the physician decision to prescribe or not G-CSF for primary and secondary FN prophylaxes. It is important that these results be incorporated in the optimisation of G-CSF prescription in the clinical setting.

Management of chemotherapy-induced febrile neutropenia and use of granulocyte colony-stimulating factor in patients with soft tissue or bone sarcoma

“…14 Patients allocated to a high-risk protocol benefit from an individualized approach according to their clinical history and risk stratification, avoiding adverse events and unnecessary hospital costs. 23 In our analyses, 21 patients, which corresponded to 82.75% of the events identified, suffered impacts on the oncological treatment plan after the FN condition, such as dose reduction (31.03%), delay (20.68%), and/or suspension (17.24%) of chemotherapy treatment. A study of breast cancer patients diagnosed with FN after chemotherapy regimens consisting of doxorubicin/cyclophosphamide/paclitaxel and doxorubicin/cyclophosphamide/docetaxel reported, respectively, that 17.1% and 63.2% of cases required dose reductions in the chemotherapy regimen and that in 14.3% and 10.5% of cases there were delays in chemotherapy treatment.…”

“…Patients allocated to a high-risk protocol benefit from an individualized approach according to their clinical history and risk stratification, avoiding adverse events and unnecessary hospital costs. 23…”

Prevalence of psychological distress and associated factors among Omani women diagnosed with breast cancer: a single-centre, cross-sectional study

“…Only women who agreed to participate and those who did not have current psychological or psychiatric illness or not currently taking any psychotropic medications were included in the study. Women who were admitted due to cancer chemotherapy complications or considered to have an oncological emergency, such as febrile neutropenia (defined as an axillary or oral temperature of ≥38.5°C or a sustained temperature of ≥38°C for 1 hour and an absolute neutrophil count (ANC) of <500 cells/mm 3 or an expected ANC decrease to <500 cells/mm 3 in the next 48 hours), or those in obvious pain were excluded from the study 19…”

Clinical and pharmacoeconomic aspects of the use of prolonged colony-stimulating factors

“…В отношении первичной и вторичной профилактики ФН при применении схем, не предусматриваю щих обязательное назначение Г-КСФ, вышеуказанное также совершенно справедливо.Результаты опросов врачей-клиницистов также демонстрируют широкую востребованность пролонгированных форм Г-КСФ. Например, результаты исследования, проведенного во Франции, показали, что более чем в 50% случаев именно пегилированный филграстим применяется для первичной профилактики ФН, при этом большинство специалистов отметило, что решаю щую роль в выборе препарата играют эффективность, стоимость и количество необходимых введений[53].ЗАКЛЮЧЕНИЕТаким образом, на современном этапе развития противоопухолевой терапии Г-КСФ являются ее неотъемлемой частью, обеспечиваю щей безопасность и оптимальные результаты лечения онкологических пациентов. Применение пролонгированных препаратов этого класса позволит повысить эффективность их назначения и положительно скажется на качестве жизни пациентов в процессе проведения противоопухолевой терапии.…”