Targeted Colony-Stimulating Factor Use in Patients at Risk for Neutropenic Complications From Breast Cancer Adjuvant Chemotherapy: Clinical Impact of a Predictive Risk Model

2.50
Hdl Handle:
http://hdl.handle.net/10755/165439
Category:
Abstract
Type:
Presentation
Title:
Targeted Colony-Stimulating Factor Use in Patients at Risk for Neutropenic Complications From Breast Cancer Adjuvant Chemotherapy: Clinical Impact of a Predictive Risk Model
Author(s):
Zobec, A.; DeGroot, J.; Mack, K.
Author Details:
A. Zobec, The Oncology Clinic, Colorado Springs, Colorado, USA; J. DeGroot; K. Mack
Abstract:
Full-dose chemotherapy improves survival in early stage breast cancer (ESBC). Delivery of at least 85% of the planned dose on time (PDOT) may be necessary for an optimal outcome, yet a significant portion of ESBC patients treated in community practice do not receive this level of dose intensity. Neutropenia is often responsible for the dose delays and reductions that result in frequent failure to reach PDOT. While prophylactic colony-stimulating factor (CSF) is an alternative to dose modifications, its universal use in all patients is not considered cost-effective. Identifying patients at risk for neutropenic complications (NC) would allow targeted use of CSF, providing cost-effective protection to the patients who need it most. Silber et al (1998) determined that the first cycle absolute neutrophil count nadir (FCANC) may be useful to stratify ESBC patients according to their risk of subsequent NC, including episodes of severe neutropenia (ANC <500 cells/mm3) and febrile neutropenia (FN), and chemotherapy dose delays and reductions. We report on the prospective application of this risk model to determine its clinical impact in a population of ESBC patients receiving standard adjuvant chemotherapy. Patients were assigned to CSF based on their FCANC: those with FCANC £500 cells/mm3 (high-risk patients; n=360) received filgrastim 5 mcg/kg/day in all subsequent cycles, while those with FCANC >500 cells/mm3 (low-risk; n=264) received filgrastim only if they developed FN or had a neutropenia-related dose modification. Study patients were compared to 1022 historical control ESBC patients treated with similar regimens. While most study patients (95%) received at least 85% PDOT, with no difference between the high-risk and low-risk groups, only 78.7% of the historical controls received at least 85% PDOT. Hospitalization and FN were more common in the high-risk patients compared to the low-risk patients, but were lower overall in the study patients than in the historical controls (2.9% vs. 7.3% and 7.5% vs. 10.3%, respectively). These results suggest that risk model-guided prophylactic CSF use improves outcomes compared to current standard practice. Nurses can proactively evaluate an individual patient’s risk using factors such as FCANC and recommend appropriate supportive therapy to help their patients achieve optimal treatment outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2003
Conference Name:
28th Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Denver, Colorado, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleTargeted Colony-Stimulating Factor Use in Patients at Risk for Neutropenic Complications From Breast Cancer Adjuvant Chemotherapy: Clinical Impact of a Predictive Risk Modelen_GB
dc.contributor.authorZobec, A.en_US
dc.contributor.authorDeGroot, J.en_US
dc.contributor.authorMack, K.en_US
dc.author.detailsA. Zobec, The Oncology Clinic, Colorado Springs, Colorado, USA; J. DeGroot; K. Macken_US
dc.identifier.urihttp://hdl.handle.net/10755/165439-
dc.description.abstractFull-dose chemotherapy improves survival in early stage breast cancer (ESBC). Delivery of at least 85% of the planned dose on time (PDOT) may be necessary for an optimal outcome, yet a significant portion of ESBC patients treated in community practice do not receive this level of dose intensity. Neutropenia is often responsible for the dose delays and reductions that result in frequent failure to reach PDOT. While prophylactic colony-stimulating factor (CSF) is an alternative to dose modifications, its universal use in all patients is not considered cost-effective. Identifying patients at risk for neutropenic complications (NC) would allow targeted use of CSF, providing cost-effective protection to the patients who need it most. Silber et al (1998) determined that the first cycle absolute neutrophil count nadir (FCANC) may be useful to stratify ESBC patients according to their risk of subsequent NC, including episodes of severe neutropenia (ANC &lt;500 cells/mm3) and febrile neutropenia (FN), and chemotherapy dose delays and reductions. We report on the prospective application of this risk model to determine its clinical impact in a population of ESBC patients receiving standard adjuvant chemotherapy. Patients were assigned to CSF based on their FCANC: those with FCANC &pound;500 cells/mm3 (high-risk patients; n=360) received filgrastim 5 mcg/kg/day in all subsequent cycles, while those with FCANC &gt;500 cells/mm3 (low-risk; n=264) received filgrastim only if they developed FN or had a neutropenia-related dose modification. Study patients were compared to 1022 historical control ESBC patients treated with similar regimens. While most study patients (95%) received at least 85% PDOT, with no difference between the high-risk and low-risk groups, only 78.7% of the historical controls received at least 85% PDOT. Hospitalization and FN were more common in the high-risk patients compared to the low-risk patients, but were lower overall in the study patients than in the historical controls (2.9% vs. 7.3% and 7.5% vs. 10.3%, respectively). These results suggest that risk model-guided prophylactic CSF use improves outcomes compared to current standard practice. Nurses can proactively evaluate an individual patient&rsquo;s risk using factors such as FCANC and recommend appropriate supportive therapy to help their patients achieve optimal treatment outcomes.en_GB
dc.date.available2011-10-27T12:18:33Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:18:33Z-
dc.conference.date2003en_US
dc.conference.name28th Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationDenver, Colorado, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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