The following is a summary of “A Pragmatic Cluster-Randomized Trial of a Standing Order Entry Intervention for Colony-Stimulating Factor Use Among Patients at Intermediate Risk for Febrile Neutropenia,” published in the January 2023 issue of Oncology by Hershman, et al.

To lessen febrile neutropenia (FN), primary prophylactic colony-stimulating factors (PP-CSFs) were recommended; however, it is unclear if these treatments were beneficial for regimens with moderate FN risk. For a study, researchers carried up a substudy to assess the efficacy of SOE for patients receiving intermediate-risk regimens as part of a pragmatic, randomized trial of a standing order entry (SOE) PP-CSF intervention.

In the cluster randomized trial known as TrACER, practitioners were assigned to either receive standard of care or an SOE intervention that was based on recommended practices. Sites in the main trial were randomized 3:1 to SOE of automated PP-CSF orders for high FN risk regimens and warnings against PP-CSF usage for low-risk regimens against normal care. 24 intervention sites were randomly allocated in a secondary 1:1 randomization to either SOE to prescribe or an alert not to prescribe PP-CSF for intermediate-risk regimens. The SOE might be ignored by clinicians. Non-small-cell lung cancer, colorectal cancer, and breast cancer patients were included. Mixed-effect logistic regression models were utilized to examine differences across randomized locations.

Between January 2016 and April 2020, 846 qualified patients on intermediate-risk regimens were registered for either an SOE to prescribe (12 sites, n = 542) or an alert not to prescribe PP-CSF (12 sites, n = 304). In sites assigned to SOE, PP-CSF usage rates were higher (37.1% v 9.9%, odds ratio, 5.91; 95% CI, 1.77 to 19.70; P =.0038). Rates of FN were low and identical between arms (3.7% v 3.7%).

FN rates were modest and did not change across arms, even though implementing an SOE intervention for PP-CSF considerably improved PP-CSF usage among patients receiving first-line intermediate-risk regimens. The findings indicated that neither SOE nor PP-CSF offered enough of a benefit to warrant their usage for all patients getting first-line intermediate-risk regimens, even though the guideline-informed SOE affected prescription.

Reference: ascopubs.org/doi/full/10.1200/JCO.22.01258