Authors: Jeff Dang, Sang Chau, Jessy Delaisla, Andrew Allan Hertler
Published: 2020-10-08
DOI: 10.1200/jco.2020.38.29_suppl.302
Source: Full article
302 Background: Myeloid growth factors (MGF) are used to prevent and treat febrile neutropenia caused by immunosuppressive therapy. In the curative setting, the use of a full dose-intensity chemotherapy plus an MGF are recommended based on the febrile neutropenic risk levels, as maintaining the full dose intensity has been shown to increase the chance of cure. In the metastatic setting, instead of administering an MGF to maintain dose-intensity, decreasing the dose and/or delaying the chemotherapy to allow recovery of the neutrophils is a reasonable alternative. This is supported by the American Society of Clinical Oncology (ASCO) where a review did not find data to support the use of MGFs to maintain dose-intensity in the treatment of metastatic cancer. In addition, no improvements in disease-free or overall survival were reported for any common cancer with the use of MGFs. New Century Health’s goal is to proactively educate and promote appropriate utilization of MGFs in the metastatic setting by incorporating several non-invasive questions into a Clinical Pathways Decision Support (CPDS) tool that aligns with ASCO’s recommendation (e.g. has a dose reduction/delay been attempted?). Methods: For a Medicare population, approved treatment requests involving the use of chemotherapy in metastatic cancer in the baseline period (baseline: January 2019 to May 2019, n = 606) were compared to requests approved in the implementation period (intervention: June 2019 to November 2019, n = 615). Two states were included in the analyses: Arizona (baseline: n = 200, intervention: n = 237) and Florida (baseline: n = 442, intervention: n = 422). Chi-square ( χ2) tests were performed to evaluate differences in requests during the baseline period as compared to the intervention period. Results: In Arizona, Florida, and total sample, treatment requests for MGF in metastatic cancer were lower in the intervention period as compared to the baseline period (Arizona: 21.52% vs. 28.50%, Florida: 18.48% vs. 23.98%, and total sample: 18.86% vs. 25.25%). In the total sample, the findings suggest that treatment requests for MGF in metastatic cancer were significantly lower in the intervention period as compared to the baseline period (χ2 = 7.25, p = .007). Conclusions: ASCO recommendations were incorporated into a CPDS tool to help align prescribing behavior. Real world data was used to help evaluate whether this change led a reduction in the utilization of MGFs in metastatic cancer. These findings suggest that such approaches can help guide providers to best practice.