Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?

Journal Article (Journal Article;Multicenter Study)

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.

Full Text

Duke Authors

Cited Authors

  • Lyman, GH; Dale, DC; Legg, JC; Abella, E; Morrow, PK; Whittaker, S; Crawford, J

Published Date

  • August 2015

Published In

Volume / Issue

  • 4 / 8

Start / End Page

  • 1153 - 1160

PubMed ID

  • 25810005

Pubmed Central ID

  • PMC4559026

Electronic International Standard Serial Number (EISSN)

  • 2045-7634

Digital Object Identifier (DOI)

  • 10.1002/cam4.454


  • eng

Conference Location

  • United States