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Open Access Highly Accessed Research article

The use of chemotherapy regimens carrying a moderate or high risk of febrile neutropenia and the corresponding management of febrile neutropenia: an expert survey in breast cancer and non-Hodgkin's lymphoma

Laetitia Gerlier1*, Mark Lamotte1, Ahmad Awada2, André Bosly3, Greet Bries4, Véronique Cocquyt5, Christian Focan6, Stéphanie Henry78, Yassine Lalami2, Jean-Pascal Machiels9, Jeroen Mebis10, Nicole Straetmans11, Didier Verhoeven12 and Luc Somers13

Author Affiliations

1 Health Economics and Outcomes Research Department, IMS Health Consulting, Medialaan 38, 1800 Vilvoorde, Belgium

2 Medical Oncology Clinic, Jules Bordet Institute, boulevard de Waterloo, 121, B-1000 Brussels, Belgium

3 Department of Hematology, University Hospital of Mont-Godinne, Avenue Dr G. Therasse, 1, B-5530 Yvoir, Belgium

4 Department of Hematology, Virga Jesse Hospital, Stadsomvaart, 11, B-3500 Hasselt, Belgium

5 Medical Oncology, University Hospital Ghent, De Pintelaan, 185, B-9000 Gent, Belgium

6 Department of Oncology, CHC-Saint-Joseph Clinic, rue de Hesbaye, 75, B-4000 Liège, Belgium

7 Department of Oncology, University Hospital of Mont-Godinne, Avenue Dr G. Therasse, 1, B-5530 Yvoir, Belgium

8 Medical Oncology, Sainte-Elisabeth Clinic, place Louise Godin, 15, B-5000 Namur, Belgium

9 Medical Oncology, UCL Saint-Luc University Hospital, Avenue Hippocrate 10, B-1200 Brussels, Belgium

10 Medical Oncology, Virga Jesse Hospital, Stadsomvaart, 11, B-3500 Hasselt, Belgium

11 Department of Hematology, Jolimont Hospital, rue Ferrer, 159, B-7100 Haine-Saint-Paul, Belgium

12 Medical Oncology, Iridiumkankernetwerk, AZ Klina, Augustijnslei 100, B-2930 Brasschaat, Belgium

13 OncoLogX, Arthur Boelstraat 66, B-2990 Wuustwezel, Belgium

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BMC Cancer 2010, 10:642  doi:10.1186/1471-2407-10-642

Published: 23 November 2010

Abstract

Background

The use of chemotherapy regimens with moderate or high risk of febrile neutropenia (defined as having a FN incidence of 10% or more) and the respective incidence and clinical management of FN in breast cancer and NHL has not been studied in Belgium. The existence of a medical need for G-CSF primary and secondary prophylaxis with these regimens was investigated in a real-life setting.

Methods

Nine oncologists and six hematologists from different Belgian general hospitals and university centers were surveyed to collect expert opinion and real-life data (year 2007) on the use of chemotherapy regimens with moderate or high risk of febrile neutropenia and the clinical management of FN in patients aged <65 years with breast cancer or NHL. Data were retrospectively obtained, over a 6-month observation period.

Results

The most frequently used regimens in breast cancer patients (n = 161) were FEC (45%), FEC-T (37%) and docetaxel alone (6%). In NHL patients (n = 39), R-CHOP-21 (33%) and R-ACVBP-14 (15%) were mainly used. Without G-CSF primary prophylaxis (PP), FN occurred in 31% of breast cancer patients, and 13% had PSN. After G-CSF secondary prophylaxis (SP), 4% experienced further FN events. Only 1 breast cancer patient received PP, and did not experience a severe neutropenic event. Overall, 30% of chemotherapy cycles observed in breast cancer patients were protected by PP/SP. In 10 NHL patients receiving PP, 2 (20%) developed FN, whereas 13 (45%) of the 29 patients without PP developed FN and 3 (10%) PSN. Overall, 55% of chemotherapy cycles observed in NHL patients were protected by PP/SP. Impaired chemotherapy delivery (timing and/or dose) was reported in 40% (breast cancer) and 38% (NHL) of patients developing FN. Based on oncologist expert opinion, hospitalization rates for FN (average length of stay) without and with PP were, respectively, 48% (4.2 days) and 19% (1.5 days). Similar rates were obtained from hematologists.

Conclusions

Despite the studied chemotherapy regimens being known to be associated with a moderate or high risk of FN, upfront G-CSF prophylaxis was rarely used. The observed incidence of severe neutropenic events without G-CSF prophylaxis was higher than generally reported in the literature. The impact on medical resources used is sizeable.