From A to Xeloda: Practical considerations for implementing a chemotherapy regimen ordering system intervention.

57 Background: SWOG S1415CD (NCT02728596) is a pragmatic trial comparing outcomes of colony stimulating factor (CSF) use in usual care with care that uses guideline-informed standing CSF orders for protocol chemotherapy regimens. To develop the regimen list, we reviewed, reconciled, and compiled a comprehensive list of 77 NCCN-recognized core regimens and 40 biologic variants for breast, non-small cell, and colorectal cancer, meant to capture a broad population and variety of practices and settings. The 24 intervention sites chose regimens representative of the 3 febrile neutropenia (FN) risk categories (high, intermediate, low) from the list to reconfigure in prescription ordering systems. The current analysis seeks to determine whether providing a comprehensive list of regimens resulted in increased enrollment of patients. Methods: For each site, we compared how many core regimens the site reconfigured to their average weekly rate of enrollment from date of first patient enrolled to 4/1/2018, controlled for cooperative group type and site-reported volume of breast, non-small cell lung, and colorectal cancer patients. For each regimen, we determined its relative popularity by tallying how many sites chose to reconfigure it for the trial. Results: Sites reconfigured an average of 56% (range: 19%-100%) of core regimens on our list. The 18 most popular core regimens chosen by 83-96% of sites provided enrollment coverage across all FN risk categories for all intervention sites and accounted for 91% of enrollment, although enrollment among those regimens varied widely (0-18% of all patients enrolled). Reconfiguring more regimens did not correlate with higher average weekly enrollment (r < 0.1). Conclusions: Studies that wish to limit the number of regimens may want to focus on the most popular regimens as identified by committee or preliminary polling. Starting from a comprehensive set of regimens for a pragmatic trial focusing on chemotherapy ordering systems takes more time to compile and vet, is more difficult to implement in databases, is a burden to sites to review and reconfigure in ordering systems, and does not necessarily translate to increased enrollment rates. Clinical trial information: NCT02728596.

Duke Scholars

Author Gary Herbert Lyman Medicine, Medical Oncology