Assessing patients’ risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?

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Abstract:
This study evaluated the correlation between the risk of febrile neutropenia (FN) estimated by physicians and the risk of severe neutropenia or FN predicted by a validated multivariate model in patients with nonmyeloid malignancies receiving chemotherapy. Before patient enrollment, physician and site characteristics were recorded, and physicians self-reported the FN risk at which they would typically consider granulocyte colony-stimulating factor (G-CSF) primary prophylaxis (FN risk intervention threshold). For each patient, physicians electronically recorded their estimated FN risk, orders for G-CSF primary prophylaxis (yes/no), and patient characteristics for model predictions. Correlations between physician-assessed FN risk and model-predicted risk (primary endpoints) and between physician-assessed FN risk and G-CSF orders were calculated. Overall, 124 community-based oncologists registered; 944 patients initiating chemotherapy with intermediate FN risk enrolled. Median physician-assessed FN risk over all chemotherapy cycles was 20.0%, and median model-predicted risk was 17.9%; the correlation was 0.249 (95% CI, 0.179−0.316). The correlation between physician-assessed FN risk and subsequent orders for G-CSF primary prophylaxis (n = 634) was 0.313 (95% CI, 0.135−0.472). Among patients with a physician-assessed FN risk ≥20%, 14% did not receive G-CSF orders. G-CSF was not ordered for 16% of patients at or above their physician's self-reported FN risk intervention threshold (median, 20.0%) and was ordered for 21% below the threshold. Physician-assessed FN risk and model-predicted risk correlated weakly; however, there was moderate correlation between physician-assessed FN risk and orders for G-CSF primary prophylaxis. Further research and education on FN risk factors and appropriate G-CSF use are needed.

Keywords:
Chemotherapy; febrile neutropenia; granulocyte colony-stimulating factor; neutropenia; primary prophylaxis; risk assessment; risk factors; risk model; severe neutropenia

Autoři: Gary H. Lyman ¹; David C. Dale ²; Jason C. Legg ³; Esteban Abella ⁴; Phuong Khanh Morrow ⁴; Sadie Whittaker ⁴; Jeffrey Crawford ⁵
Působiště autorů: Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 2Department of Medicine, University of Washington, Seattle, Washington ¹; Global Biostatistical Science, Amgen Inc., Thousand Oaks, California ³; Hematology/Oncology, Amgen Inc., Thousand Oaks, California ⁴; Department of Medicine, Duke University School of Medicine and Duke Cancer Institute, Durham, North Carolina ⁵
Vyšlo v časopise: Cancer Medicine 2015; 4(8)
Kategorie: Original Research
prolekare.web.journal.doi_sk: https://doi.org/10.1002/cam4.454

© 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Souhrn

Keywords:
Chemotherapy; febrile neutropenia; granulocyte colony-stimulating factor; neutropenia; primary prophylaxis; risk assessment; risk factors; risk model; severe neutropenia

Zdroje

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