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Edgar Castillo MD. Brian Boulmay MD. Hematology/Oncology LSUHSC

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.

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Edgar Castillo MD. Brian Boulmay MD. Hematology/Oncology LSUHSC

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  1. 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

  2. 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

  3. 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 Filgrastimand Pegfilgrastim, currently have FDA approval for use in the prevention of chemotherapy-induced neutropenia Support Care Cancer 2005;13:522-528

  4. Study • LSU Interim Hospital in New Orleans • Hematology – Oncology service • 21 admissions with FN as primary diagnosis in 2012 • Retrospective chart review • Objectives: • identify if growth factors and prophylactic antibiotics had been included in the treatment plan of the patients admitted with FN in 2012. • Give recommendations to the cancer committee as applicable.

  5. 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 R-CHOP, 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

  6. 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

  7. 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.

  8. References • 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 ClinOncol 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) • Taxolsingle agent (Gill PS et al. Paclitaxel is safe and effective in the treatment of advanced AIDS-related Kaposi’s sarcoma. J ClinOncol 1999; 17:1876)

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