Prophylactic pegylated granulocyte colony-stimulating factor (pGCSF) is given with the first cycle of chemotherapy in the neoadjuvant, adjuvant, or metastatic setting risk of neutropenic fever associated with individual chemotherapy regimens. Primary prophylactic pGCSF is suggested when a chemotherapy regimen has a greater than 20% risk of neutropenic fever.
A multidisciplinary team reviewed the charts of patients with non-small-cell lung cancer (NSCLC) at the Taussig Cancer Institute and initiated a new chemotherapy regimen from April through November 2013.
108 patients with NSCLC received a new chemotherapy regimen during the specified period. 34 of 119 patients (28%) treated with LRNF chemotherapy received pGCSF. Each patient received an average of 2.6 doses of pGCSF (total, 89 amounts). Analysis during the change period revealed 4% of patients with NSCLC treated with LRNF chemotherapy received pGCSF. Cost analysis showed an 84% decrease in billed charges per month. No increase in neutropenic fever admissions was found.
pGCSF was excessively prescribed for patients with NSCLC. Simply raising awareness helped providers to change their ordering practices. Improvement continued after the education session and was sustained as one completed the last two PDSA cycles. Herefore, one can easily track the prescribing appropriateness level, and one can give provider feedback promptly. Interventions to address these gaps quickly produced improved compliance with guidelines and led to significant cost savings.