Real-world use of granulocyte colony-stimulating factor in ambulatory breast cancer patients: a cross-sectional study
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To prevent febrile neutropenia (FN), European Organisation for Research and Treatment of Cancer (EORTC) guidelines recommend primary prophylaxis with granulocyte colony-stimulating factors (PPG) for patients at high risk (≥ 20%) of FN. In Belgium, the use of PPG is restricted by specific reimbursement criteria. The impact of these criteria on PPG use and adherence to guidelines is unknown.
This multicentre, cross-sectional, observational study aimed to describe PPG use by FN risk category in breast cancer patients who were scheduled to receive myelosuppressive chemotherapy in outpatient clinics in Belgium during a 2-week period between 13 October and 12 December 2014.
In total, 490 patients were enrolled. Median age was 57.0 years. Based on their chemotherapy regimen, 53.9, 5.1 and 41.0% of patients were at a low, intermediate and high risk of FN, respectively. Overall, 39.8% of patients received PPG (17.0, 12.0 and 73.1% of those receiving low-, intermediate- and high-risk regimens, respectively). In the high-risk category, PPG was used in 89.9% of dose-dense and in 25.0% of classical chemotherapy regimens. PPG use was adherent to EORTC guidelines in 75.3% of patients (30.6% appropriate use, 44.7% appropriate non-use). EORTC guidelines would recommend PPG use in 46.1% of this study population (n = 226), and its use was reimbursable in Belgium in 76.1% of these patients (n = 172), but only 66.4% of them received PPG (n = 150).
Both Belgian reimbursement criteria and physician decision-making led to a proportion of patients for whom PPG treatment was recommended but finally not receiving it.
KeywordsBreast cancer Chemotherapy Febrile neutropenia Granulocyte colony-stimulating factor Prophylaxis
Authors had access to primary data, analyses and study reports. Qualified researchers may request data from Amgen clinical studies. Complete details are available at the following: http://www.amgen.com/datasharing.
Amgen Inc. ran and funded this study, all analyses and the medical writing support. Medical writing support, funded by Amgen Belgium, was provided by Kelly Soady PhD of Oxford PharmaGenesis, Oxford, UK.
Compliance with ethical standards
Florence Van Rijckegem, Chloë Haverbeke, Wim Wynendaele and Simon Van Belle have no conflicts of interest to disclose; Guy Jerusalem disclosed consulting fees from Amgen; Luc Somers is an external consultant to Amgen BeLux; Anke Van den broeck and Sofie Vingerhoedt are employees of Amgen BeLux.
Conflicts of interest
The authors declare that they have no conflicts of interest.
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