White blood cell growth factor use in anoutpatient oncology clinic: Lessons andopportunities learned

摘要

The increased use and high cost associated with white blood cell growth factors at our outpatient oncology clinic hasprompted this evaluation. The objectives of this study were to categorize the indication for use of pegfilgrastim andfilgrastim; evaluate the administration of these white blood cell growth factors; identify opportunities for cost savings; andidentify ways to increase prescriber adherence to evidence-based practice guidelines. This medication use evaluationstudy involved retrospective data collection from patient medical records. Adult oncology patients treated in the out-patient oncology clinic who received filgrastim or pegfilgrastim were identified and included in this study. Computerizedpatient records were used to collect data on patient demographics, risk factors for febrile neutropenia, prescribingpatterns for filgrastim and pegfilgrastim, and chemotherapy regimens. The number of pegfilgrastim and filgrastim doseswere predominately used for primary prophylaxis following chemotherapy treatment. Of the 234 total doses of pegfil-grastim used in the setting of primary prophylaxis, 28 (12%), 134 (57%), and 72 (31%) doses were given to patientsreceiving chemotherapy regimens associated with a high risk (>20%), intermediate risk (10-20%), and low risk (< 10%) offebrile neutropenia, respectively. The total number of pegfilgrastim doses used in secondary prophylaxis was 78; 20 (26%)and 58 (74%) of these doses were given to patients receiving chemotherapy regimens associated with an intermediaterisk and low risk of febrile neutropenia, respectively. This study revealed a significant portion of prescribed growth factoruse that was not in accordance with clinical practice guidelines.