Treatment delays during FOLFOX chemotherapy in patients with colorectal cancer: a multicenter retrospective analysis

Kogan, Lawrence; Davis, S. Lindsey; Brooks, Gabriel A.

doi:10.21037/jgo.2019.07.03

Cited by 11 publications

(7 citation statements)

References 17 publications

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“…No validated ANC level has been established for safety. 2,4,5,19 Despite this, we have shown that physicians in the community use this strategy.…”

Section: Discussionmentioning

confidence: 95%

“…A retrospective chart review was carried out for every patient receiving mFOLFOX6 in the curative setting (oxaliplatin 85mg/m 2 IV day 1, leucovorin 400 mg/m 2 IV day 1, 5FU 400mg/m 2 IV day 1 followed by 2400 mg/m 2 All comers at both sites with pathology confirming early-stage colon or rectal cancer, as well as completely resected metastatic cases receiving mFOLFOX6 in the adjuvant setting in the above time frames were included. There was no institutional protocol mandating chemotherapy dose delay, dose modification, or the use of G-CSF based on lab values.…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

“…3 An effective, safe and economical strategy to deal with these adverse outcomes is needed. 2 We have reported an approach of using adjuvant FOLFOX at low ANC and platelet counts. 4 Neither dose delay nor G-CSF was used, but occasional minor dose modification allowed safe, on-time treatment with minimal treatment delay and excellent RDI.…”

Section: Introductionmentioning

confidence: 99%

“…The adjuvant systemic treatment of early-stage colon and rectal cancer with FOLFOX chemotherapy improves survival. 1 The low rate of chemotherapy-induced febrile neutropenia (CIFN) and the high rate of neutropenia and thrombocytopenia causing chemotherapy dose delay 2 and reduced dose intensity 3 have been described. However, the exact clinical thinking causing these outcomes has not.…”

Section: Introductionmentioning

confidence: 99%

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A Community Hospital-Based Study: A Prespecified Neutrophil Count with Adjuvant mFOLFOX6 Associated with Increased Delays, Increased G-CSF Use, and Reduced Dose Intensity

Chiarotto

Dranitsaris²

2021

CMAR

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Purpose: To look at how the absolute neutrophil count (ANC) is used by community oncologists as the main factor in ordering adjuvant mFOLFOX6 for colorectal cancer. This study reports on how this decision impacts chemotherapy delays, effects received dose intensity (RDI), and increases the use of granulocyte-colony-stimulating factor (G-CSF). Methods: A retrospective chart review was conducted for all patients receiving adjuvant mFOLFOX6 for colorectal cancer at a two-site community hospital in Toronto, Ontario, Canada, between July 2013 and March 2019. Seven physicians treated 140 patients, who made 1636 clinic visits to receive 1461 cycles of prescribed chemotherapy. Results: The mean ANC per physician associated with a decision to give chemotherapy ranged from 1.05×10 9 /L (95% CI 0.98-1.13×10 9 /L) to 1.5x10 9 /L with a decision to delay if the ANC was lower. Subsequent cycles were then supported by G-CSF with very similar ANC decision levels for dose delay. Physicians were more likely to prescribe chemotherapy with higher pretreatment ANC, r=0.3 (p<0.000). G-CSF was used in 24.6% of cycles and usage had grown to 44.2% by the 12th cycle; physician use ranged from 0.36% to 54.2% of cycles. Secondary prophylaxis was the indication in 94.7% of cases. There was an inverse relationship between the frequency of G-CSF use and the RDI of continuous infusion 5FU, r=−0.26 (p<0.001). There were delays for 8.8% of visits for cycles not supported by G-CSF and, surprisingly, 15.9% of visits for cycles supported by G-CSF. Neutropenia caused 61.6% of delays for chemotherapy cycles not supported by G-CSF and 44.1% for cycles supported by G-CSF. Conclusion: Physicians required a pretreatment ANC of 1.05-1.5×10 9 /L before prescribing mFOLFOX6 chemotherapy. When ANC was low, a dose delay and secondary prophylaxis with G-CSF failed to consistently achieve the much sought after ANC. This then caused more delay, reduced RDI and increased expense for both patients and the system. Fewer delays, less G-CSF and increased RDI would have resulted with reduced reliance on ANC and adoption of chemotherapy dose reduction.

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“…No validated ANC level has been established for safety. 2,4,5,19 Despite this, we have shown that physicians in the community use this strategy.…”

Section: Discussionmentioning

confidence: 95%

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Community Hospital-Based Study: A Prespecified Neutrophil Count with Adjuvant mFOLFOX6 Associated with Increased Delays, Increased G-CSF Use, and Reduced Dose Intensity

Chiarotto

Dranitsaris²

2021

CMAR

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“…6,7 Reductions in dose intensity due to dose modifications, dose delays, or chemotherapy discontinuation may compromise treatment efficacy, 8 and treatment delays can also present a substantial burden to patients, with the need to reschedule visits leading to inefficiencies and greater costs to health care systems. 9 Moreover, supportive care interventions are lineage specific, are often used reactively, and are each associated with risks and limitations.…”

Section: Introductionmentioning

confidence: 99%

Trilaciclib prior to chemotherapy reduces the usage of supportive care interventions for chemotherapy‐induced myelosuppression in patients with small cell lung cancer: Pooled analysis of three randomized phase 2 trials

Ferrarotto

Anderson

Medgyasszay³

et al. 2021

Cancer Medicine

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Evidence to guide the optimal timing for pre‐chemotherapy blood tests for early breast, colorectal cancer and diffuse large B‐cell lymphoma

Chambers

Förster

et al. 2021

Cancer Medicine

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Background Re‐designing services and processes to meet growing demands in chemotherapy services is necessary with increasing treatments. There is little evidence guiding the timing and thresholds to be attained of pre‐chemotherapy blood assessments, namely neutrophils. Methods A survey was developed and distributed to health professionals in the United Kingdom (UK) to examine current practice in timing and threshold values of neutrophils and platelets before treatment administration. This was followed by a retrospective cohort study, using data from electronic patient record systems; including patients initiating treatment between January 2013 and December 2018, to determine a safe timeframe for blood assessments; comparing neutrophil, platelet, creatinine and bilirubin levels at different time points. Results The survey captured 25% of hospitals in the UK and variations were apparent in both the timing of assessments and thresholds needed, particularly for neutrophils. 616 (6.5%) of 4007 patients included had neutrophil levels measured twice within 7 days of treatment (with the first level taken beyond 3 days and the second test being within 3 days of treatment‐ the UK standard). Of the patients that attained an acceptable neutrophil level at their first test, five of the 616 (0.8%) became ineligible for administration from the test 2 level. 23% of patients improved their grade and became eligible for treatment. Little difference was observed for platelets. Conclusions We have demonstrated that extending the timeframe for blood tests can be safe, however, this practice may cause unnecessary delays for patients if only an early test is relied on for eligibility.

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Treatment delays during FOLFOX chemotherapy in patients with colorectal cancer: a multicenter retrospective analysis

Cited by 11 publications

References 17 publications

A Community Hospital-Based Study: A Prespecified Neutrophil Count with Adjuvant mFOLFOX6 Associated with Increased Delays, Increased G-CSF Use, and Reduced Dose Intensity

A Community Hospital-Based Study: A Prespecified Neutrophil Count with Adjuvant mFOLFOX6 Associated with Increased Delays, Increased G-CSF Use, and Reduced Dose Intensity

Trilaciclib prior to chemotherapy reduces the usage of supportive care interventions for chemotherapy‐induced myelosuppression in patients with small cell lung cancer: Pooled analysis of three randomized phase 2 trials

Evidence to guide the optimal timing for pre‐chemotherapy blood tests for early breast, colorectal cancer and diffuse large B‐cell lymphoma

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