1456P - Underutilization of G-CSF in elderly cancer patients – an issue that needs to be urgently addressed

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Supportive Measures
Presenter Marika Saar
Citation Annals of Oncology (2016) 27 (6): 497-521. 10.1093/annonc/mdw390
Authors M. Saar1, I. Sei2, J. Jaal3
  • 1Pharmacy, Tartu University Hospital, 50406 - Tartu/EE
  • 2Pharmacy Institute, Tartu University, Tartu/EE
  • 3Hematology-oncology Clinic, Tartu University Hospital, Tartu/EE

Abstract

Background

Chemotherapy-induced febrile neutropenia (FN) is a potentially life-threatening side-effect of chemotherapy. Prophylactic use of granylocyte colony stimulating factors (G-CSF) reduces the risk of FN. G-CSFs also appear to reduce cost and improve patients' quality of life. The aim of our study was to assess the use of G-CSF among elderly cancer patients (≥70 years), i.e. in a group of patients with shortest survival rates.

Methods

We conducted a retrospective medical record review in tertiary hospital. A total of 176 chemotherapy order forms from January to February 2015 were analyzed. The use of G-CSF was compared to European Organization for Research and Treatment of Cancer and National Comprehensive Cancer Network guidelines.

Results

Out of 176 patients, 82 were male and 94 female. The patients were 70 to 93 years old (average 76.4). The most common diagnose among men was colorectal cancer (n = 31) and among women breast cancer (n = 36). Chemotherapy regimens with high risk of FN were prescribed to 13 (4.2%) and with intermediate risk to 13 (4.2%) patients. According to the guidelines, prophylactic use of G-CSF is indicated for all patients with high risk regimens and for selected patients (with additional risk factors, including age >65) with intermediate risk regimens. Our study revealed that none of the elderly patients in intermediate risk chemotherapy group received G-CSF. Moreover, most of these elderly patients had 1 or more additional risk factors (female gender, previous chemotherapy/radiation, previous neutropenia, recent surgery, poor performance status, poor renal and liver function), due to which the prophylactic use of G-CSF would have been indicated. Most importantly, we found that none of patients in high risk chemotherapy group received G-CSF which poses serious risk of developing FN leading to treatment failure.

Conclusions

Our study indicated a significant underutilization of G-CSF in elderly cancer patients, especially in those receiving regimens with high risk of FN. Latter may be one of the reasons of worse outcome of cancer therapy and thereby shorter survival seen in this age-group. Underutilization of G-CSF in elderly is an issue that needs to be urgently addressed.

Clinical trial identification

Legal entity responsible for the study

Tartu University Hospital

Funding

Tartu University Hospital

Disclosure

All authors have declared no conflicts of interest.