Growth factor usage patterns and outcomes in the community setting: Collection through a practice-based computerized clinical information system

Purpose: Although use of colony-stimulating factor (CSF) is widespread and guidelines far use have been disseminated, actual practice patterns of medi cal oncologists are unknown. The purpose of; this study was to collect thes e data using an office-based computerized clinical information system. Patients and Methods: Data were collected on patients at 10 community-based oncology practices, Information regarding CSF use wets captured at the tim e of prescribing through a computerized clinical support tool and stored in a data warehouse, and an analysis was carried out retrospectively. Results: A total of 6,813 cancer regimens administered ta 5,034 patients we re evaluated for growth factor use. Overall, CSFs were used in 14% of regim ens, with breast, lymphoma, lung, and ovarian being the most common cancers for which CSfs were used. In 49.4% of regimens, CSF was initiated during c ycle 1, with an average duration of 1 week, and wets used in two or three c ycles per regimen. Afebrile neutropenia is rarely followed by CSF initiatio n. Granulocyte colony-stimulating factor (G-CSF) is associated with fewer d ose adjustments, delays, and hospitalizations when compared with granulocyt e-macrophage colony stimulating factor (GM-CSF), There is wide variation am ong oncologists in CSF use, and several substantial differences were noted between the prescribing behavior of American Society of Clinical Oncology ( ASCO) survey reported oncologists and actual clinical practice, as captured by the computerized clinical information system. Conclusion: Computerized clinical information systems can collect detailed information regarding practice patterns of medical oncologists. ASCO physic ian practice survey data do not accurately reflect actual practice patterns and must be interpreted with caution. Substantial deviations from ASCO gro wth factor guidelines remain, and oncologists' use of CSFs demonstrates wid e variation. There may be important clinical differences between G-CSF and GM-CSF, but definitive phase ill trials are needed for confirmation. J Clin Oncol 18:1764-1770. (C) 2000 by American Society of Clinical Oncolog y.