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

Publication ,  Journal Article
Lyman, GH; Dale, DC; Legg, JC; Abella, E; Morrow, PK; Whittaker, S; Crawford, J
Published in: Cancer Med
August 2015

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.

Duke Scholars

Published In

Cancer Med

DOI

EISSN

2045-7634

Publication Date

August 2015

Volume

4

Issue

8

Start / End Page

1153 / 1160

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk
  • Physicians
  • Neoplasms
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Granulocyte Colony-Stimulating Factor
 

Citation

APA
Chicago
ICMJE
MLA
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Lyman, G. H., Dale, D. C., Legg, J. C., Abella, E., Morrow, P. K., Whittaker, S., & Crawford, J. (2015). Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk? Cancer Med, 4(8), 1153–1160. https://doi.org/10.1002/cam4.454
Lyman, Gary H., David C. Dale, Jason C. Legg, Esteban Abella, Phuong Khanh Morrow, Sadie Whittaker, and Jeffrey Crawford. “Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?Cancer Med 4, no. 8 (August 2015): 1153–60. https://doi.org/10.1002/cam4.454.
Lyman GH, Dale DC, Legg JC, Abella E, Morrow PK, Whittaker S, et al. Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk? Cancer Med. 2015 Aug;4(8):1153–60.
Lyman, Gary H., et al. “Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk?Cancer Med, vol. 4, no. 8, Aug. 2015, pp. 1153–60. Pubmed, doi:10.1002/cam4.454.
Lyman GH, Dale DC, Legg JC, Abella E, Morrow PK, Whittaker S, Crawford J. Assessing patients' risk of febrile neutropenia: is there a correlation between physician-assessed risk and model-predicted risk? Cancer Med. 2015 Aug;4(8):1153–1160.
Journal cover image

Published In

Cancer Med

DOI

EISSN

2045-7634

Publication Date

August 2015

Volume

4

Issue

8

Start / End Page

1153 / 1160

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Risk
  • Physicians
  • Neoplasms
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Granulocyte Colony-Stimulating Factor