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ASCO Quality Care 2017: Reducing Overuse of Colony-Stimulating Factors in Febrile Neutropenia Without Compromising Patient Safety

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Key Points

  • Colony-stimulating factors use was relatively unchanged in the control group in the periods before and after the program implementation.
  • There was a reduction from 48.4% to 35.6% in colony-stimulating factors use for those in the case group.
  • There was no evidence of increased febrile neutropenia risk over and above trend changes in the control states. 

In a retrospective cohort study, Adeboyeje et al found that a utilization management tool that makes real-time care recommendations can help reduce overuse of substances that assist the bone marrow in producing blood cells, called colony-stimulating factors, in attempts to prevent fevers in patients receiving chemotherapy with a low concentration of neutrophils white blood cells, known as febrile neutropenia. Their findings were presented at the 2017 Quality Care Symposium (Abstract 52) and published in the Journal of Oncology Practice.

Colony-stimulating factors have been shown to reduce the risk and severity of febrile neutropenia, but their use has diverted from guideline recommendations and resulted in overuse. Initiatives that increase awareness of guideline recommendations and reduce the use of low-value practices continue to emerge in the oncology field. The findings from this study suggest that overuse of colony-stimulating factors in patients with lung cancer receiving chemotherapy can be better addressed through a utilization management tool.

Study Findings

Implementation of a utilization management tool (a Web portal) that assessed the risk of febrile neutropenia and made recommendations for or against colony-stimulating factors occurred in oncology practices across 9 U.S. states. Using the tool, oncologists could request colony-stimulating factor support and receive automated real-time recommendations based on the expected febrile neutropenia risk of the planned regimen for a specific patient. 

Using administrative claims data, researchers looked at 3,467 patients and identified 707 and 1,150 case patients with lung cancer in practices with the tool in the periods before and after the implementation, respectively. The control group contained 636 and 974 patients with lung cancer in the corresponding time periods in practices where the tool was not implemented. Colony-stimulating factor use and febrile neutropenia rates were compared adjusting for baseline febrile neutropenia risk factors.

In the adjusted results, colony-stimulating factor use was relatively unchanged in the control group in the periods before and after the program implementation, while there was a reduction from 48.4% to 35.6% in colony-stimulating factor use for those in the case group. There was no evidence of increased febrile neutropenia risk over and above trend changes in the control states.

Future research could examine impact of utilization management tools on other patient outcomes, such as delays in chemotherapy or immune recovery.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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