USE OF HEMATOPOIETIC COLONY-STIMULATING FACTORS - THE AMERICAN-SOCIETY-OF-CLINICAL-ONCOLOGY SURVEY

Purpose: Dissemination of use of the hematopoietic colony-stimulating factors (CSFs) is unprecedented in oncology, with almost all physician s having experience with granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GMCSF) shortly a fter the drugs received Food and Drug Administration (FDA) approval in 1991. The American Society of Clinical Oncology (ASCO) Health Service s Research Committee sought to assess patterns of use of CSFs before d issemination of its first-ever publication of ASCO guidelines. Methods : A questionnaire describing clinical scenarios was mailed to American oncologists and hematologists who practice medical oncology. In each scenario, the physician wets asked whether he would prefer to use a CS F to prevent or treat neutropenia. Results: The response rate to the m ailed survey was 49% (N = 475). Most physicians preferred to use CSFs for secondary prophylaxis in patients receiving chemotherapy at rates of 44% to 85%, rather than reduce doses. patterns of use did not diffe r for palliative, curative, or adjuvant chemotherapy. While the majori ty of CSF patterns of care were similar to those recommended in the AS CO guidelines. more than half of the physicians chose to use CSFs in t he treatment of febrile neutropenia, an area not supported in the subs equent guidelines. In general, physicians at academic medical centers and in Health Maintenance Organization (HMO) practices were more likel y to prefer dose-reduction strategies over addition of CSFs, while fee -for-service physicians preferred the opposite strategies. Conclusion: Variations in CSF preferences for use were related to differences in clinical characteristics (history of afebrile v febrile neutropenia), drug characteristics (G-CSF or GM-CSF), and physician practice charact eristics (HMO or fee-for-service setting). However, before disseminati on of the guidelines, the majority of American oncologists preferred s trategies that were subsequently included in the ASCO CSF guidelines. CSF guidelines would be most likely to reduce CSF use for treatment of afebrile and uncomplicated febrile neutropenia. (C) 1996 by American Society of Clinical Oncology.