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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

(2010) BMC CANCER. 10.
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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.
Keywords
CHOP, COLONY-STIMULATING FACTOR, RECOMMENDATIONS, MORTALITY, GROWTH-FACTORS, DOSE INTENSITY, CLINICAL-PRACTICE, QUALITY-OF-LIFE, PATIENTS RECEIVING CHEMOTHERAPY, OBSERVATIONAL EUROPEAN NEUTROPENIA

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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.
@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 <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, André 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},
  keywords     = {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},
}

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