Does expanded access to primary prophylaxis with G-CSF decrease the burden of febrile neutropenia?

ABSTRACT

Category Management/measurement of side-effects of treatment (acute or late), including patient-reported outcome measures (PROMs) Purpose: Guidelines recommend primary prophylaxis (PP) with haematopoietic colony stimulating factors (CSFs) in chemotherapy with a >=20% risk of febrile neutropenia (FN). During the COVID-19 pandemic, guidelines temporarily supported routine use of G-CSF as PP for intermediate risk regimens. Our retrospective real-world data compares hospital admissions for FN during a period of expanded access (June to December 2020) against baseline use (June to December 2019) in a district general UK hospital. Methods and materials The process measure was the proportion of patients prescribed PP with G-CSF when initiating a new intermediate/low-risk regimen/month. The outcome measure was the monthly rate of hospital admissions for FN in intermediate/low-risk regimens. Statistical process control (SPC) charts and chi-square tests were used for analysis. Result(s) Use of G-CSF as PP showed statistically significant special cause variation on SPC p-charts consistent with policy change. Median PP prescription rate in June to December 2019 was 0.9% (interquartile range (IQR) 0-2.6%) and June to December 2020 was 34.8% (IQR 29%-43%). Monthly G-CSF prescriptions for all indications was a median of 3% (2019) versus 70% (2020). However, the trends in admissions for FN were stable on SPC p-charts with a median monthly event rate of 0.63% in 2019 and 0.66% in 2020. Summary statistics showed 12 events/698 unique patients in 2019 (1.72%) and ten events/618 patients in 2020 (1.62%), (p=0.8). Conclusion(s) Despite significantly increased use of PP with G-CSF for intermediate/low-risk chemotherapy, the burden of hospitalisations for FN remained unchanged and was lower than expected. Copyright © 2022