Abstract 2767: Consistency of standing orders for primary prophylactic CSF within a national network of community oncology practices: SWOG intergroup trial S1415CD
Authors: Ramsey Scott , Hershman Dawn , Bell-Brown Ari , Watabayashi Kate , Kreizenbeck Karma , Sullivan Sean , Bansal Aasthaa , Barlow William , Arnold Kathryn , Lyman Gary 
Published: July 2017

BACKGROUND

Among the 400,000 individuals undergoing chemotherapy for breast, colorectal and lung cancer in the US, many are at risk of febrile neutropenia (FN). Prophylactic colony stimulating factor (CSF) use reduces the risk of FN, yet studies show that 55%-95% of CSF prescribing is inconsistent with clinical practice guidelines. There is lack of evidence and ambiguous guidelines for CSF use in regimens with an intermediate risk of FN. To address these issues, we are conducting a pragmatic trial to assess CSF prescribing and to generate evidence about CSF efficacy with intermediate risk regimens. To inform the design and sample size needs, we conducted a survey of current CSF order system use within a large network of community oncology practices.

METHODS

The study setting are sites within the NCI Community Oncology Research Program (NCORP), a national network across the U.S. and Puerto Rico that conducts multi-site cancer clinical trials. Between January-September 2016, 58 NCORP practices were surveyed on their existing systems for prescribing CSF prophylaxis.

RESULTS

8 clinics (14%) reported that their sites do not use any standing orders for CSF prophylaxis prescribing. Standing order set characteristics for the remaining 50 practices are shown in Table 1.

Table 1Summary of CSF standing order implementation in 50 surveyed NCORP clinicsBreast Cancer RegimensNon-Small Cell Lung Cancer RegimensColorectal Cancer RegimensOrder Set CharacteristicDose DenseHigh RiskIntermediate RiskLow RiskIntermediate RiskLow RiskIntermediate RiskLow RiskN (%)N (%)N (%)N (%)N (%)N (%)N (%)N (%)Automatically Included in Order Set (Standing Orders)46 (82%)31 (62%)7 (14%)08 (16%)07 (14%)0Automatically Excluded in Order Set 006 (12%)19 (38%)5 (10%)19 (38%)8 (16%)19 (38%)No automatic ordering- up to physician discretion to add or exclude orders4 (8%)19 (38%)37 (74%)31 (62%)37 (74%)31 (62%)35 (670%)31 (62%)

CONCLUSIONS

We observed wide variation in the current application of standing orders. Intermediate risk regimens had the most inconsistent practices, with a near equal number of clinics choosing either actively including or excluding CSF order sets. The majority of clinics using standing orders included CSF for dose dense and high risk regimens but only 19 (38%) actively excluded CSF for low risk regimens. These results support the need for more evidence to inform clearer guidelines on CSF use in intermediate risk regimens and studies that evaluate the effects of existing CSF standing orders on guideline adherence and patient outcomes.

Funding:PCORI (PCS-1402-09988) and NCORP grant (5UG1CA189974)

Citation Format: Scott Ramsey, Dawn Hershman, Ari Bell-Brown, Kate Watabayashi, Karma Kreizenbeck, Sean Sullivan, Aasthaa Bansal, William Barlow, Kathryn Arnold, Gary Lyman. Consistency of standing orders for primary prophylactic CSF within a national network of community oncology practices: SWOG intergroup trial S1415CD [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2767. doi:10.1158/1538-7445.AM2017-2767