Mastering Colony Stimulating Factor Use among Lung Cancer Patients Receiving Chemotherapy

It’s up to oncologists and their patients to make many, often tough, treatment decisions. For those treating patients receiving chemotherapy, the risk of those patients developing febrile neutropenia – or fever and infection due to lowered white blood cell counts – is a very real concern.

Though treatment with colony stimulating factor (CSF) has been shown to reduce the risk and severity of febrile neutropenia in patients at high risk, its use is not universally beneficial. If not used in appropriate patients, febrile neutropenia and other neutropenic complications may lessen a patient’s chances of survival (Lyman).  If used when not needed, a patient may endure adverse events such as intense bone pain and increased costs with little to no benefit.

The American Society of Clinical Oncologists developed guidelines recommending against CSF for prevention of neutropenia for patients with less than a 20 percent risk of infection (Smith).  Despite that advice, a recent study showed that 26 percent of low-risk patients still received CSF (Ramsey).

To address this issue, AIM Specialty Health, a specialty benefits management company and wholly-owned subsidiary of Anthem, Inc., developed a real-time, CSF utilization management “tool” to be used in the doctor’s office. The tool allowed oncologists to request CSF support and receive automated real-time recommendations based on the expected febrile neutropenia risk of the planned regimen for a specific patient.

HealthCore conducted a study to measure if the tool facilitated safer and more appropriate use of CSF.  We evaluated thousands of patients with lung cancer in nine states, comparing outcomes of patients whose doctors used the tool to those of patients whose doctor did not use the tool. Use of CSF for low to moderate-risk patients for whom the tool was used dropped from 48 percent to 36 percent, while the control group remained unchanged. Importantly, the rates for patients hospitalized for febrile neutropenia for whom the tool was used remained the same, providing evidence there was no drop in the quality of care.

While HealthCore acknowledges that these kinds of treatment decisions remain difficult, we also hope that by using decision support tools like the one created by AIM, oncologists can reduce overuse of CSF without harming patients, or increasing hospital admission rates – a win-win for doctors and their patients.

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