In a study reported in the Journal of Clinical Oncology, Dawn L. Hershman, MD, MS, FASCO, and colleagues found that a standing order entry (SOE) for vs an alert against use of primary prophylactic colony-stimulating factor (PP-CSF) for patients receiving first-line regimens for cancer associated with an intermediate risk of febrile neutropenia resulted in greater use of PP-CSF but no difference in the incidence of febrile neutropenia.
As stated by the investigators, “PP-CSFs are prescribed to reduce [febrile neutropenia] but their benefit for intermediate [febrile neutropenia] risk regimens is uncertain. Within a pragmatic, randomized trial of a standing order entry PP-CSF intervention, we conducted a substudy to evaluate the effectiveness of SOE for patients receiving intermediate-risk regimens.”
Dawn L. Hershman, MD, MS, FASCO
The current substudy was performed within the cluster randomized TrACER trial, in which practices in the SWOG Cancer Research Network and the National Cancer Institute Community Oncology Research Program were randomly assigned to usual care or a guideline-based SOE intervention for high- and low-risk regimens for febrile neutropenia. In the substudy, 24 sites were randomly assigned to either an SOE to prescribe (n = 12) or an alert to not prescribe (n =12) PP-CSF for first-line intermediate-risk regimens. Clinicians were permitted to countermand the SOE. Patients enrolled at the sites had been diagnosed with breast, colorectal, or non–small cell lung cancers.
Between January 2016 and April 2020, 846 eligible patients receiving intermediate-risk regimens were enrolled at sites with an SOE to prescribe (n = 542) or those with an alert to not prescribe PP-CSF (n = 304). Rates of PP-CSF use were 37.1% at sites randomly assigned to an SOE vs 9.9% at sites randomly assigned to an alert to not prescribe PP-CSF (odds ratio = 5.91, 95% CI = 1.77–19.70, P = .0038). Rates of febrile neutropenia were 3.7% in both groups. Rates of febrile neutropenia among patients who did not receive PP-CSF were 3.8% at the SOE sites and 4.1% at sites with an alert against PP-CSF.
The investigators concluded, “Although implementation of an SOE intervention for PP-CSF significantly increased PP-CSF use among patients receiving first-line intermediate-risk regimens, [febrile neutropenia] rates were low and did not differ between arms. Although this guideline-informed SOE influenced prescribing, the results suggest that neither SOE nor PP-CSF provides sufficient benefit to justify their use for all patients receiving first-line intermediate-risk regimens.”
Dr. Hershman, of Columbia University, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Patient-Centered Outcomes Research Institute and National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
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