Journal Article
. 2011 Jun; 103(12):979-82.
doi: 10.1093/jnci/djr152.

Use of colony-stimulating factors with chemotherapy: opportunities for cost savings and improved outcomes

Arnold L Potosky 1 Jennifer L Malin  Benjamin Kim  Elizabeth A Chrischilles  Solomon B Makgoeng  Nadia Howlader  Jane C Weeks  
Affiliations
  • PMID: 21670423
  •     14 References
  •     45 citations

Abstract

Myeloid colony-stimulating factors (CSFs) decrease the risk of febrile neutropenia (FN) from high-risk chemotherapy regimens administered to patients at 20% or greater risk of FN, but little is known about their use in clinical practice. We evaluated CSF use in a multiregional population-based cohort of lung and colorectal cancer patients (N = 1849). Only 17% (95% confidence interval [CI] = 8% to 26%) patients treated with high-risk chemotherapy regimens received CSFs, compared with 18% (95% CI = 16% to 20%) and 10% (95% CI = 8% to 12%) of patients treated with intermediate- (10%-20% risk of FN) and low-risk (<10% risk of FN) chemotherapy regimens, respectively. Using a generalized estimating equation model, we found that enrollment in a health maintenance organization (HMO) was strongly associated with a lower adjusted odds of discretionary CSF use, compared with non-HMO patients (odds ratio = 0.44, 95% CI = 0.32 to 0.60, P < .001). All statistical tests were two-sided. Overall, 96% (95% CI = 93% to 98%) of CSFs were administered in scenarios where CSF therapy is not recommended by evidence-based guidelines. This finding suggests that policies to decrease CSF use in patients at lower or intermediate risk of FN may yield substantial cost savings without compromising patient outcomes.

Use of hematopoietic colony-stimulating factors: comparison of the 1994 and 1997 American Society of Clinical Oncology surveys regarding ASCO clinical practice guidelines. Health Services Research Committee of the American Society of Clinical Oncology.
C L Bennett, J A Weeks, +2 authors, T J Smith.
J Clin Oncol, 1999 Nov 05; 17(11). PMID: 10550166
Growth factor usage patterns and outcomes in the community setting: collection through a practice-based computerized clinical information system.
G Swanson, K Bergstrom, +2 authors, E T Herfindal.
J Clin Oncol, 2000 Apr 14; 18(8). PMID: 10764438
Development of a new head and neck cancer-specific comorbidity index.
Jay F Piccirillo, Peter D Lacy, Arindam Basu, Edward L Spitznagel.
Arch Otolaryngol Head Neck Surg, 2002 Oct 09; 128(10). PMID: 12365889
Perspectives on the value of American Society of Clinical Oncology clinical guidelines as reported by oncologists and health maintenance organizations.
Charles L Bennett, Mark R Somerfield, +4 authors, American Society of Clinical Oncology.
J Clin Oncol, 2003 Mar 01; 21(5). PMID: 12610197
Prognostic importance of comorbidity in a hospital-based cancer registry.
Jay F Piccirillo, Ryan M Tierney, +2 authors, Edward L Spitznagel.
JAMA, 2004 May 27; 291(20). PMID: 15161894
Highly Cited.
Understanding cancer treatment and outcomes: the Cancer Care Outcomes Research and Surveillance Consortium.
John Z Ayanian, Elizabeth A Chrischilles, +13 authors, Dee W West.
J Clin Oncol, 2004 Jul 31; 22(15). PMID: 15284250
Highly Cited.
Surveillance of colony-stimulating factor use in US academic health centers.
J M Yim, K A Matuszewski, +3 authors, P H Vlasses.
Ann Pharmacother, 1995 May 01; 29(5). PMID: 7544655
NCCN guidelines advocate wider use of colony-stimulating factor.
Caroline McNeil.
J Natl Cancer Inst, 2005 May 19; 97(10). PMID: 15900037
2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline.
Thomas J Smith, James Khatcheressian, +19 authors, Antonio C Wolff.
J Clin Oncol, 2006 May 10; 24(19). PMID: 16682719
Highly Cited.
Myeloid growth factors. Clinical practice guidelines in oncology.
Jeffrey Crawford, Betsy Althaus, +22 authors, National Comprehensive Cancer Network (NCCN).
J Natl Compr Canc Netw, 2007 Mar 06; 5(2). PMID: 17335688
Use of colony-stimulating factors for chemotherapy-associated neutropenia: review of current guidelines.
Michael Heuser, Arnold Ganser, +3 authors, European Organization for Research and Treatment of Cancer.
Semin Hematol, 2007 Jul 17; 44(3). PMID: 17631179
Review.
Impact of primary prophylaxis on febrile neutropenia within community practices in the US.
Dawn Hershman, Dana Hurley, +2 authors, Jennifer L Malin.
J Med Econ, 2009 Sep 03; 12(3). PMID: 19723018
Adverse events among the elderly receiving chemotherapy for advanced non-small-cell lung cancer.
Elizabeth A Chrischilles, Jane F Pendergast, +8 authors, Robert H Fletcher.
J Clin Oncol, 2009 Dec 30; 28(4). PMID: 20038726    Free PMC article.
Colony-stimulating factor prescribing patterns in patients receiving chemotherapy for cancer.
Scott D Ramsey, Jeannine S McCune, +4 authors, Sean D Sullivan.
Am J Manag Care, 2010 Sep 30; 16(9). PMID: 20873955
Personalized medicine and cancer supportive care: appropriate use of colony-stimulating factor support of chemotherapy.
Nicole M Kuderer, Gary H Lyman.
J Natl Cancer Inst, 2011 Jun 15; 103(12). PMID: 21670422    Free PMC article.
Re: personalized medicine and cancer supportive care: appropriate use of colony-stimulating factor support of chemotherapy.
Arnold L Potosky, Jennifer L Malin, +2 authors, Jane C Weeks.
J Natl Cancer Inst, 2011 Nov 01; 103(24). PMID: 22036767    Free PMC article.
Uptake and economic impact of first-cycle colony-stimulating factor use during adjuvant treatment of breast cancer.
Dawn L Hershman, Elizabeth T Wilde, +4 authors, Alfred I Neugut.
J Clin Oncol, 2012 Feb 09; 30(8). PMID: 22312106    Free PMC article.
A way forward on the medically appropriate use of white cell growth factors.
Thomas J Smith, Bruce E Hillner.
J Clin Oncol, 2012 Mar 01; 30(14). PMID: 22370327    Free PMC article.
Review.
Medical oncologists' perceptions of financial incentives in cancer care.
Jennifer L Malin, Jane C Weeks, +2 authors, Nancy L Keating.
J Clin Oncol, 2012 Dec 28; 31(5). PMID: 23269996    Free PMC article.
Neutropenia and G-CSF in lymphoproliferative diseases.
Roberto Ria, Antonia Reale, +2 authors, Angelo Vacca.
Hematology, 2013 Jan 17; 18(3). PMID: 23321273    Free PMC article.
Colony-stimulating factors for febrile neutropenia during cancer therapy.
Charles L Bennett, Benjamin Djulbegovic, LeAnn B Norris, James O Armitage.
N Engl J Med, 2013 Mar 22; 368(12). PMID: 23514290    Free PMC article.
Review.
The MASCC Neutropenia, Infection and Myelosuppression Study Group evaluates recent new concepts for the use of granulocyte colony-stimulating factors for the prevention of febrile neutropenia.
Jean Klastersky, Harry Raftopoulos, Bernardo Rapoport.
Support Care Cancer, 2013 Mar 26; 21(6). PMID: 23525960
Primary prophylaxis with hematopoietic colony stimulating factor: insights from a Canadian cost-effectiveness analysis.
Scott A Strassels, Michael Dickson, Leann B Norris, Charles L Bennett.
J Natl Cancer Inst, 2013 Jul 23; 105(15). PMID: 23873406    Free PMC article.
Comparison of pegfilgrastim prescribing practice to national guidelines at a university hospital outpatient oncology clinic.
Geralyn E Waters, Patricia Corrigan, Mandy Gatesman, Thomas J Smith.
J Oncol Pract, 2013 Aug 15; 9(4). PMID: 23942922    Free PMC article.
Review.
Neutropenia management and granulocyte colony-stimulating factor use in patients with solid tumours receiving myelotoxic chemotherapy--findings from clinical practice.
K Krzemieniecki, P Sevelda, +7 authors, J Maenpaa.
Support Care Cancer, 2013 Oct 25; 22(3). PMID: 24154740    Free PMC article.
Study design: two long-term observational studies of the biosimilar filgrastim Nivestim™ (Hospira filgrastim) in the treatment and prevention of chemotherapy-induced neutropenia.
Didier Kamioner, Stefan Fruehauf, +3 authors, Christian Berthou.
BMC Cancer, 2013 Nov 19; 13. PMID: 24237790    Free PMC article.
Granulocyte colony-stimulating factor (G-CSF) patterns of use in cancer patients receiving myelosuppressive chemotherapy.
Mi Rim Choi, Craig A Solid, +4 authors, Thomas J Arneson.
Support Care Cancer, 2014 Feb 05; 22(6). PMID: 24492928
Feasibility and safety of a reduced duration of therapy of colony-stimulating factor in a dose-dense regimen.
Luigi Rigacci, Benedetta Puccini, +4 authors, Alberto Bosi.
Support Care Cancer, 2014 Apr 18; 22(9). PMID: 24740178    Free PMC article.
Use of colony-stimulating factor in patients with ovarian cancer receiving paclitaxel and carboplatin in Japan.
Kenichi Harano, Akihiro Hirakawa, +3 authors, Noriyuki Katsumata.
J Gynecol Oncol, 2014 Apr 25; 25(2). PMID: 24761216    Free PMC article.
Are specialty drug prices destroying insurers and hurting consumers?: a number of efforts are under way to reduce price pressure.
Stephen Barlas.
P T, 2014 Aug 20; 39(8). PMID: 25136254    Free PMC article.
Increasing utilization and predictors of hematopoietic growth factors in patients diagnosed with colorectal cancer: findings from a large national population-based cohort in the USA, 1992-2009.
Yefei Zhang, Shuang-Shuang Fu, Xianglin L Du.
Med Oncol, 2014 Sep 19; 31(10). PMID: 25231751
Granulocyte colony-stimulating factors as prophylaxis against febrile neutropenia.
Sol Cortés de Miguel, Miguel Ángel Calleja-Hernández, Salomón Menjón-Beltrán, Inmaculada Vallejo-Rodríguez.
Support Care Cancer, 2014 Oct 07; 23(2). PMID: 25284722
Review.
G-CSF utilization rate and prescribing patterns in United States: associations between physician and patient factors and GCSF use.
Gisoo Barnes, Ashutosh Pathak, Lee Schwartzberg.
Cancer Med, 2014 Nov 21; 3(6). PMID: 25410813    Free PMC article.
Review.
Adherence to granulocyte-colony stimulating factor (G-CSF) guidelines to reduce the incidence of febrile neutropenia after chemotherapy--a representative sample survey in Germany.
Hartmut Link, J Nietsch, +2 authors, Supportive Care Group (ASORS) of the German Cancer Society (DKG).
Support Care Cancer, 2015 Jun 18; 24(1). PMID: 26081593
Cancer care burden: aiming at the Achilles heel.
S Ahmed, R K Shahid, K Gesy.
Curr Oncol, 2015 Jun 20; 22(3). PMID: 26089722    Free PMC article.
Comparison of EP2006, a filgrastim biosimilar, to the reference: a phase III, randomized, double-blind clinical study in the prevention of severe neutropenia in patients with breast cancer receiving myelosuppressive chemotherapy.
K Blackwell, V Semiglazov, +8 authors, N Harbeck.
Ann Oncol, 2015 Jul 01; 26(9). PMID: 26122726    Free PMC article.
Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology.
Erin E Kent, Sandra A Mitchell, +8 authors, Steven B Clauser.
J Clin Oncol, 2015 Jul 22; 33(24). PMID: 26195715    Free PMC article.
Risk of chemotherapy-induced febrile neutropenia with early discontinuation of pegfilgrastim prophylaxis in US clinical practice.
Derek Weycker, Xiaoyan Li, +6 authors, Jacob Garcia.
Support Care Cancer, 2015 Dec 17; 24(6). PMID: 26670915    Free PMC article.
Burden of Chemotherapy-Induced Febrile Neutropenia Hospitalizations in US Clinical Practice, by Use and Patterns of Prophylaxis with Colony-Stimulating Factor.
Derek Weycker, Xiaoyan Li, +5 authors, Gary H Lyman.
Support Care Cancer, 2016 Oct 14; 25(2). PMID: 27734153
Impact of recommended weight-based dosing of granulocyte-colony stimulating factors in acute leukemia and stem cell transplant patients.
Jennifer K Hockings, Diwura K Owolabi, Joyce E Broyles, Susan C Wheelis.
Support Care Cancer, 2017 Jan 26; 25(6). PMID: 28120115
Can Appealing to Patient Altruism Reduce Overuse of Health Care Services? An Experimental Survey.
Kevin R Riggs, Peter A Ubel, Brendan Saloner.
J Gen Intern Med, 2017 Feb 06; 32(7). PMID: 28155043    Free PMC article.
Incidence of Neutropenia in Veterans Receiving Lung Cancer Chemotherapy: A Comparison of Administrative Coding and Electronic Laboratory Data.
Sarah Knerr, Elaine Y Hu, Steven B Zeliadt.
EGEMS (Wash DC), 2017 May 02; 5(1). PMID: 28459084    Free PMC article.
Pooled analysis of two randomized, double-blind trials comparing proposed biosimilar LA-EP2006 with reference pegfilgrastim in breast cancer.
K Blackwell, P Gascon, +5 authors, N Harbeck.
Ann Oncol, 2017 Jun 24; 28(9). PMID: 28637287    Free PMC article.
A stakeholder-informed randomized, controlled comparative effectiveness study of an order prescribing intervention to improve colony stimulating factor use for cancer patients receiving myelosuppressive chemotherapy: the TrACER study.
Aasthaa Bansal, Sean D Sullivan, +4 authors, Scott D Ramsey.
J Comp Eff Res, 2017 Jul 08; 6(5). PMID: 28686055    Free PMC article.
Refining the role of pegfilgrastim (a long-acting G-CSF) for prevention of chemotherapy-induced febrile neutropenia: consensus guidance recommendations.
Matti Aapro, Ralph Boccia, +10 authors, Vicente Valero.
Support Care Cancer, 2017 Aug 27; 25(11). PMID: 28842778    Free PMC article.
Review.
Time trends in utilization of G-CSF prophylaxis and risk of febrile neutropenia in a Medicare population receiving adjuvant chemotherapy for early-stage breast cancer.
Ravi K Goyal, Spiros Tzivelekis, +2 authors, James A Kaye.
Support Care Cancer, 2017 Sep 19; 26(2). PMID: 28921379
Efficacy, safety and proper dose analysis of PEGylated granulocyte colony-stimulating factor as support for dose-dense adjuvant chemotherapy in node positive Chinese breast cancer patients.
Fan Zhang, RuiXia LingHu, +5 authors, Junlan Yang.
Oncotarget, 2017 Nov 08; 8(45). PMID: 29108384    Free PMC article.
Medication overuse in oncology: current trends and future implications for patients and society.
Stephen M Schleicher, Peter B Bach, Konstantina Matsoukas, Deborah Korenstein.
Lancet Oncol, 2018 Apr 04; 19(4). PMID: 29611528    Free PMC article.
Review.
Appropriateness of granulocyte colony-stimulating factor use in patients receiving chemotherapy by febrile neutropenia risk level.
Hassam Baig, Barbara Somlo, +3 authors, Phuong K Morrow.
J Oncol Pharm Pract, 2018 Sep 12; 25(7). PMID: 30200842    Free PMC article.
Incidence of febrile neutropenia during chemotherapy among patients with nonmyeloid cancer receiving filgrastim vs a filgrastim biosimilar.
Lee S Schwartzberg, Lincy S Lal, +4 authors, Stephanie Korrer.
Clinicoecon Outcomes Res, 2018 Sep 15; 10. PMID: 30214262    Free PMC article.
A Survey of Oncologists' Perceptions and Opinions Regarding the Use of Granulocyte Colony-Stimulating Factors.
Alicia Hawkins, Alysa Murphy, +3 authors, Michael A Kelsh.
J Cancer Educ, 2019 Oct 28; 35(1). PMID: 31656028    Free PMC article.
Sulfated polymannuroguluronate TGC161 ameliorates leukopenia by inhibiting CD4+ T cell apoptosis.
Chuanqin Shi, Wenwei Han, +11 authors, Xin Wang.
Carbohydr Polym, 2020 Aug 25; 247. PMID: 32829850    Free PMC article.
Lenograstim and filgrastim in the febrile neutropenia prophylaxis of hospitalized patients: efficacy and cost of the prophylaxis in a retrospective survey.
Rolando Innocenti, Luigi Rigacci, +9 authors, Alberto Bosi.
J Blood Med, 2019 Jan 16; 10. PMID: 30643475    Free PMC article.
Predicting neutropenia risk in patients with cancer using electronic data.
Pamala A Pawloski, Avis J Thomas, +3 authors, Gary H Lyman.
J Am Med Inform Assoc, 2016 Sep 18; 24(e1). PMID: 27638907    Free PMC article.
Real-world use of granulocyte colony-stimulating factor in ambulatory breast cancer patients: a cross-sectional study.
Florence Van Ryckeghem, Chloë Haverbeke, +5 authors, Simon Van Belle.
Support Care Cancer, 2018 Aug 14; 27(3). PMID: 30099601
Use and effectiveness of pegfilgrastim prophylaxis in US clinical practice:a retrospective observational study.
Derek Weycker, Robin Doroff, +6 authors, Gary H Lyman.
BMC Cancer, 2019 Aug 11; 19(1). PMID: 31399079    Free PMC article.
The impact of granulocyte colony-stimulating factor use in patients with metastatic breast cancer treated with palliative chemotherapy: a single-institution retrospective review.
Luay Mousa, Julie A Stephens, +9 authors, Robert Wesolowski.
Support Care Cancer, 2020 Mar 19; 28(11). PMID: 32185556
Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice.
Ahuva Averin, Amanda Silvia, +8 authors, Derek Weycker.
Support Care Cancer, 2020 Sep 04; 29(4). PMID: 32880732    Free PMC article.
Long-term patient reported outcomes and hematologic toxicity among patients who received Granulocyte-Colony Stimulating Factors during chemotherapy for early breast cancer.
Pietro Lapidari, Arnauld Gbenou, +17 authors, Antonio Di Meglio.
Breast, 2021 Mar 13; 57. PMID: 33711699    Free PMC article.