Growth factor practice patterns among pediatric oncologists: Results of a 1998 Pediatric Oncology Group survey

The American Society of Clinical Oncology (ASCO) guidelines on growth facto r (GF) use recommend applying adult-derived guidelines in pediatric oncolog y. An ASCO survey of adult oncology GF use determined the preference for fi rst degree prophylaxis (use of GF when febrile neutropenia [FN] is expected to be high in untreated patients), second-degree prophylaxis (administrati on of GF after a documented episode of FN on a previous cycle of chemothera py), and intervention in the treatment of FN. Similar preferences have not been evaluated in pediatrics. The purpose of this study was to (1) characte rize GF use in pediatric oncology; (2) correlate use patterns with demograp hic factors; and (3) compare the Pediatric Oncology Group (POG) and ASCO su rveys. The ASCO survey was revised for use within pediatric oncology and wa s mailed to the physician membership of FOG; 341 were returned (85% complet ion rate). Comparisons were made with the ASCO survey. Most (76%) physician s said GF use was determined by protocol requirements and most (70%) patien ts were entered on FOG protocols. GF use as first-degree prophylaxis was se lected 40% of the time, which was significantly greater than in adults; thi s was most influenced by anticipated duration of neutropenia (greater than or equal to 7 days). The severity of the initial clinical course (eg, neutr openia, infection) influenced use in second-degree prophylaxis; dose reduct ion alone was never selected. For FN, GF use was 45%, with lower preference s in uncomplicated FN (16%-38%) compared with complicated FN (66%). FOG res pondents endorse greater use of GF for first and second-degree prophylaxis but less use in uncomplicated FN than do ASCO respondents. These patterns m ay reflect different strategies, including the role of chemotherapy, value of dose intensity, and perceived toxicity of regimens. Given these differen ces, adult-based guidelines may not be appropriate for pediatrics.