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- Title
Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?
- Authors
Lyman, Gary H.; Dale, David C.; Legg, Jason C.; Abella, Esteban; Morrow, Phuong Khanh; Whittaker, Sadie; Crawford, Jeffrey
- Abstract
This study evaluated the correlation between the risk of febrile neutropenia ( FN) estimated by physicians and the risk of severe neutropenia or FN predicted by a validated multivariate model in patients with nonmyeloid malignancies receiving chemotherapy. Before patient enrollment, physician and site characteristics were recorded, and physicians self-reported the FN risk at which they would typically consider granulocyte colony-stimulating factor (G- CSF) primary prophylaxis ( FN risk intervention threshold). For each patient, physicians electronically recorded their estimated FN risk, orders for G- CSF primary prophylaxis (yes/no), and patient characteristics for model predictions. Correlations between physician-assessed FN risk and model-predicted risk (primary endpoints) and between physician-assessed FN risk and G- CSF orders were calculated. Overall, 124 community-based oncologists registered; 944 patients initiating chemotherapy with intermediate FN risk enrolled. Median physician-assessed FN risk over all chemotherapy cycles was 20.0%, and median model-predicted risk was 17.9%; the correlation was 0.249 (95% CI, 0.179−0.316). The correlation between physician-assessed FN risk and subsequent orders for G- CSF primary prophylaxis ( n = 634) was 0.313 (95% CI, 0.135−0.472). Among patients with a physician-assessed FN risk ≥20%, 14% did not receive G- CSF orders. G- CSF was not ordered for 16% of patients at or above their physician's self-reported FN risk intervention threshold (median, 20.0%) and was ordered for 21% below the threshold. Physician-assessed FN risk and model-predicted risk correlated weakly; however, there was moderate correlation between physician-assessed FN risk and orders for G- CSF primary prophylaxis. Further research and education on FN risk factors and appropriate G- CSF use are needed.
- Subjects
CANCER chemotherapy; FEBRILE neutropenia; GRANULOCYTE-colony stimulating factor; DENTAL prophylaxis; DISEASE risk factors; RISK assessment
- Publication
Cancer Medicine, 2015, Vol 4, Issue 8, p1153
- ISSN
2045-7634
- Publication type
Article
- DOI
10.1002/cam4.454