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The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin's lymphoma

Laetitia Gerlier, Mark Lamotte, Ahmad Awada, André Bosly, Greet Bries, Veronique Cocquyt UGent, Christian Focan, Stephanie Henry, Yassine Lalami and Jean-Pascal Machiels, et al. (2010) BMC CANCER. 10.
abstract
Background: The use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting. Methods: Nine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged <65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period. Results: The most frequently used regimens in breast cancer patients (n = 161) were FEC (45%), FEC-T (37%) and docetaxel alone (6%). In NHL patients (n = 39), R-CHOP-21 (33%) and R-ACVBP-14 (15%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31% of breast cancer patients, and 13% had PSN. After G-CSF secondary prophylaxis (SP), 4% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20%) developed FN, whereas 13 (45%) of the 29 patients without PP developed FN and 3 (10%) PSN. Overall, 55% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40% (breast cancer) and 38% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48% (4.2 days) and 19% (1.5 days). Similar rates were obtained from hematologists. Conclusions: Despite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
CHOP, COLONY-STIMULATING FACTOR, RECOMMENDATIONS, MORTALITY, GROWTH-FACTORS, DOSE INTENSITY, CLINICAL-PRACTICE, QUALITY-OF-LIFE, PATIENTS RECEIVING CHEMOTHERAPY, OBSERVATIONAL EUROPEAN NEUTROPENIA
journal title
BMC CANCER
BMC Cancer
volume
10
article_number
642
pages
10 pages
Web of Science type
Article
Web of Science id
000285553500001
JCR category
ONCOLOGY
JCR impact factor
3.153 (2010)
JCR rank
66/181 (2010)
JCR quartile
2 (2010)
ISSN
1471-2407
DOI
10.1186/1471-2407-10-642
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
1195807
handle
http://hdl.handle.net/1854/LU-1195807
date created
2011-03-23 17:49:56
date last changed
2011-03-31 15:13:47
@article{1195807,
  abstract     = {Background: The use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10\% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting.
Methods: Nine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged {\textlangle}65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period.
Results: The most frequently used regimens in breast cancer patients (n = 161) were FEC (45\%), FEC-T (37\%) and docetaxel alone (6\%). In NHL patients (n = 39), R-CHOP-21 (33\%) and R-ACVBP-14 (15\%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31\% of breast cancer patients, and 13\% had PSN. After G-CSF secondary prophylaxis (SP), 4\% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30\% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20\%) developed FN, whereas 13 (45\%) of the 29 patients without PP developed FN and 3 (10\%) PSN. Overall, 55\% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40\% (breast cancer) and 38\% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48\% (4.2 days) and 19\% (1.5 days). Similar rates were obtained from hematologists.
Conclusions: Despite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.},
  articleno    = {642},
  author       = {Gerlier, Laetitia and Lamotte, Mark and Awada, Ahmad and Bosly, Andr{\'e} and Bries, Greet and Cocquyt, Veronique and Focan, Christian and Henry, Stephanie and Lalami, Yassine and Machiels, Jean-Pascal and Mebis, Jeroen and Straetmans, Nicole and Verhoeven, Didier and Somers, Luc},
  issn         = {1471-2407},
  journal      = {BMC CANCER},
  keyword      = {CHOP,COLONY-STIMULATING FACTOR,RECOMMENDATIONS,MORTALITY,GROWTH-FACTORS,DOSE INTENSITY,CLINICAL-PRACTICE,QUALITY-OF-LIFE,PATIENTS RECEIVING CHEMOTHERAPY,OBSERVATIONAL EUROPEAN NEUTROPENIA},
  language     = {eng},
  pages        = {10},
  title        = {The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin's lymphoma},
  url          = {http://dx.doi.org/10.1186/1471-2407-10-642},
  volume       = {10},
  year         = {2010},
}

Chicago
Gerlier, Laetitia, Mark Lamotte, Ahmad Awada, André Bosly, Greet Bries, Veronique Cocquyt, Christian Focan, et al. 2010. “The Use of Chemotherapy Regimens Carrying a Moderate or High Risk of Febrile Neutropenia and the Corresponding Management of Febrile Neutropenia: An Expert Survey in Breast Cancer and non-Hodgkin’s Lymphoma.” Bmc Cancer 10.
APA
Gerlier, L., Lamotte, M., Awada, A., Bosly, A., Bries, G., Cocquyt, V., Focan, C., et al. (2010). The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin’s lymphoma. BMC CANCER, 10.
Vancouver
1.
Gerlier L, Lamotte M, Awada A, Bosly A, Bries G, Cocquyt V, et al. The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin’s lymphoma. BMC CANCER. 2010;10.
MLA
Gerlier, Laetitia, Mark Lamotte, Ahmad Awada, et al. “The Use of Chemotherapy Regimens Carrying a Moderate or High Risk of Febrile Neutropenia and the Corresponding Management of Febrile Neutropenia: An Expert Survey in Breast Cancer and non-Hodgkin’s Lymphoma.” BMC CANCER 10 (2010): n. pag. Print.