Download Study 2012: Evaluating adherence to supportive care guidelines for

Interim LSU Hospital (ILH) Study 2012:
Evaluating adherence to supportive
care guidelines for patients admitted to
ILH for neutropenic fever
Edgar Castillo MD.
Brian Boulmay MD.
Hematology/Oncology
LSUHSC
Background
• Febrile neutropenia (FN) is a major dose-limiting
toxicity of chemotherapy, often requiring prolonged
hospitalization and broad-spectrum antibiotic use
• Major cause of dose reductions, treatment delays,
which may compromise clinical outcomes
• Studies have demonstrated that prophylactic use of
colony-stimulating factors (CSFs) and antibiotics
can reduce the risk, severity, and duration of FN
• Studies have shown that about 25-40% of treatment
naive patients develop FN with common
chemotherapy regimens
Support Cancer Ther 2003;1:23-35
Drugs 2002;62 Suppl 1:1-15
• FN is an Oncological emergency with high mortality
rates
• Development of FN also increases diagnostic and
treatment costs and often leads to longer hospital
stays
• In addition, correlations have been reported
between changes in neutrophil counts and quality
of life, as measured by physical functioning, vitality,
and mental health
• Growth factors like Filgrastim and Pegfilgrastim,
currently have FDA approval for use in the
prevention of chemotherapy-induced neutropenia
Support Care Cancer 2005;13:522-528
Study
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LSU Interim Hospital in New Orleans
Hematology – Oncology service
21 admissions with FN as primary diagnosis in 2012
Retrospective chart review
Objectives:
o identify if growth factors and prophylactic
antibiotics had been included in the treatment
plan of the patients admitted with FN in 2012.
o Give recommendations to the cancer
committee as applicable.
Results
• 21 charts with FN as primary admitting diagnosis
were reviewed
• Eleven patients (six on hyper-CVAD and five on 7+3)
received prophylactic antibiotics; they all had an
indication for antibiotic prophylaxis according to
commonly accepted guidelines.
• Fourteen patients (six on hyper-CVAD, three on RCHOP, three on 7+3 and two on DCF) received
growth factor as part of their treatment. Per
guidelines, it was only indicated in 11 of them
• Seven patients (one on FOLFOX, one on weekly
Cisplatin + radiotherapy, two on DCF, and two on
Cisplatin + Etoposide) did not receive prophylactic
antibiotics or growth factors, also consistent with
commonly accepted treatment guidelines
Conclusion
• After evaluating the characteristics of
chemotherapy related neutropenic fever
admissions to the LSU Interim Hospital, we have
come to the conclusion that guidelines for
prophylactic antibiotics and growth factors use
were followed. Based on these data, we have no
recommendations to the cancer committee, other
than to encourage clinicians to use the treatment
templates provided in EPIC which are built with
commonly accepted supportive care agents.
References
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Hyper-CVAD (Thomas DA et al. Outcome with the hyper-CVAD regimens in
lymphoblastic leukemia. Blood 2004; 104:1624)
R-CHOP (Habermann TM et al. Rituximab-CHOP versus CHOP alone or with
maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin
Oncol 2006; 24:3121)
7+3 (Wiernik PH et al. Cytarabine plus idarubicin or daunorubicin as induction and
consolidation therapy for previously untreated adult patients with acute myeloid
leukemia. Blood 1992; 79:313)
Cisplatin/Etoposide (Moertel CG et al. Treatment of neuroendocrine carcinoma
with combined etoposide and cisplatin. Evidence of major therapeutic activity in
the anaplastic variants of these neoplasms. Cancer 1991; 68:227)
Weekly Cisplatin + RT (Forastiere AA et al. Concurrent chemotherapy and
radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med
2003; 349:2091)
Folfox (Andre, T et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant
treatment for colon cancer. N Engl J Med 2004; 350:2343)
Taxol single agent (Gill PS et al. Paclitaxel is safe and effective in the treatment of
advanced AIDS-related Kaposi’s sarcoma. J Clin Oncol 1999; 17:1876)