Background
Methods
Q. How old are you? |
1. ≤29 |
2. 30–34 |
3. 35–39 |
4. 40–44 |
5. 45–49 |
6. 50–54 |
7. 55–59 |
8. ≥60 |
Q. In what decade did you receive your medical license? |
1. 2000s |
2. 1990s |
3. 1980s |
4. 1970s |
Q. Please select one of the following to indicate your area of specialty. |
(For Group ML) |
1. Board-certified internist |
2. Board-certified hematologist |
3. Board-certified oncologist |
4. Not applicable |
(For Group BC) |
1. Board-certified surgeon |
2. Board-certified breast surgeon |
3. Board-certified oncologist |
4. Board-certified internist |
5. Not applicable |
Q. Please select one of the following to indicate your place of employment. |
1. Academic medical center |
2. Cancer center or public hospital |
3. Private hospital |
4. Other |
Diffuse large B-cell lymphoma (DLBCL) |
A 68-year-old woman was given a diagnosis of DLBCL, Stage IV A. There were hepatic metastases, but no bone marrow infiltration. She had no clinically significant past medical history. The International Prognostic Index was high-intermediate risk. Performance status (PS) was 0. Lactate dehydrogenase (LDH) was 1,250 IU/L. She was scheduled to receive six cycles of R-CHOP (rituximab 375 mg/m2 on day 1 or day 2, cyclophosphamide 750 mg/m2 on day 1, doxorubicin 50 mg/m2 on day 1, vincristine 1.4 mg/m2 on day 1 [max 2 mg], prednisone 100 mg on days 1–5) given every 21 days. |
Breast cancer |
A 68-year-old postmenopausal woman was given a diagnosis of right breast cancer, cT2N0M0 stage II A. She had no clinically significant past medical history. PS was 0. Right total mastectomy was performed. Pathological findings were as follows: pT 2.0 cm, grade 3, ly-, v-, pN1 (3/20), ER(-), PgR(-), HER2(-). She was scheduled to receive four cycles of TC (docetaxel 75 mg/m2 on day 1, cyclophosphamide 600 mg/m2 on day 1) given every 21 days. |
Q1. Would you manage low-risk febrile neutropenia in patients such as those describe above on an inpatient or outpatient basis? |
1. Outpatient |
2. Inpatient |
Q2. (For those who chose outpatient management) Which of the following choices do you feel most closely describes the treatment you usually provide to this type of patient? |
1. Oral antibiotics only |
2. Oral antibiotics and G-CSF |
3. Observation |
4. Other |
Q3. (For those who chose inpatient management) Which of the following choices do you feel most closely describes the treatment you usually provide to this type of patient? |
1. Intravenous antibiotics |
2. Intravenous antibiotics and G-CSF |
3. Other |
[Clinical Course] |
On the tenth day of the first cycle, she presented with a fever of 39 °C. A systematic review was unrevealing. Dietary and fluid intake was sufficient. |
Blood pressure, 135/80 mmHg |
HEENT: She had a clear oropharynx. |
Chest: No rales or wheezes were present. |
Cardiac: Normal S1 and S2. There was no murmur. |
Abdomen: Soft and flat. Bowel sounds were normal. |
Laboratory data: WBC:1,200/mm3, ANC:400/mm3, Hb:11.4 g/dL, PLT:158,000, GOT:23 IU/L, Alb:3.6 g/dL, BUN:18.8 mg/dL, Cr:0.6 mg/dL, CRP:1.8 mg/dL |
Q4. How do you modify the dose of subsequent courses of chemotherapy after febrile neutropenia? Please select one of the following options. |
1. Dose reduction is not required |
2. Dose reduction is required if febrile neutropenia was treated by intravenous antibiotics |
3. Dose reduction is required at any rate |
4. Other |
Q5. How do you use antibiotics for the subsequent course of chemotherapy after febrile neutropenia? Please select one of the following options. |
1. Antimicrobial prophylaxis deserves consideration |
2. Antibiotics should be taken into account when the next episode of febrile neutropenia occurs |
3. I typically do not administer antibiotics |
4. Other |
Q6. How do you use G-CSF for the subsequent course of chemotherapy after febrile neutropenia? Please select one of the following options. |
1. G-CSF prophylaxis deserves consideration |
2. G-CSF should be taken into account when neutropenia occurs |
3. G-CSF should be taken into account when the next episode of febrile neutropenia occurs |
4. I typically do not administer G-CSF |
5. Other |
Q7. Regarding systems for managing adverse effects of outpatient chemotherapy, please check all appropriate responses. |
1. Emergency outpatient unit is open at all hours |
2. Clinical laboratory is open at all hours |
3. Diagnostic imaging unit is open at all hours |
4. Hospital antibiogram is available |
5. Health professionals provide patient and family education |
6. Chemotherapy telephone helpline is available |
7. Not applicable |
Results
Characteristic | Group ML (n = 185) | Group BC (n = 160) | ||||
---|---|---|---|---|---|---|
Number | % | Number | % | |||
Age (years) | ≤29 | 5 | 3 | ≤29 | 1 | 1 |
30–34 | 22 | 12 | 30–34 | 12 | 8 | |
35–39 | 30 | 16 | 35–39 | 33 | 21 | |
40–44 | 37 | 20 | 40–44 | 31 | 19 | |
45–49 | 43 | 23 | 45–49 | 39 | 24 | |
50–54 | 28 | 15 | 50–54 | 23 | 14 | |
55–59 | 13 | 7 | 55–59 | 16 | 10 | |
≥60 | 7 | 4 | ≥60 | 5 | 3 | |
Decade of medical license | 2000s | 44 | 24 | 2000s | 33 | 21 |
1990s | 88 | 48 | 1990s | 72 | 45 | |
1980s | 46 | 25 | 1980s | 46 | 29 | |
1970s | 7 | 4 | 1970s | 9 | 6 | |
Specialty | Board-certified internist | 142 | 77 | Board-certified surgeon | 131 | 82 |
Board-certified hematologist | 141 | 76 | Board-certified breast surgeon | 58 | 36 | |
Board-certified oncologist | 18 | 10 | Board-certified oncologist | 17 | 11 | |
Not applicable | 15 | 8 | Board-certified internist | 10 | 6 | |
Not applicable | 8 | 5 | ||||
Type of clinic/hospital | Academic medical center | 59 | 32 | Academic medical center | 33 | 21 |
Cancer center or public hospital | 59 | 32 | Cancer center or public hospital | 46 | 29 | |
Private hospital | 67 | 36 | Private hospital | 69 | 43 | |
Other | 0 | 0 | Other | 12 | 8 |
Group ML | Group BC | |||||
---|---|---|---|---|---|---|
(n = 185) | (n = 160) | |||||
Number | % | Number | % | P-value | ||
Q. Inpatient versus outpatient management | ||||||
Outpatient | 93 | 50 | 104 | 65 | P = 0.006 | |
Inpatient | 92 | 50 | 56 | 35 | P = 0.006 | |
Total | 185 | 100 | 160 | 100 | ||
Q. (For those who chose outpatient management) Treatment of FN | ||||||
Oral antibiotics only | 14 | 15 | 47 | 45 | P < 0.001 | |
Oral antibiotics and G-CSF | 76 | 82 | 55 | 53 | P < 0.001 | |
Observation | 0 | 0 | 2 | 2 | P = 0.499 | |
Other | 3 | 3 | 0 | 0 | P = 0.103 | |
Total | 93 | 100 | 104 | 100 | ||
Q. (For who choose inpatient management) Treatment of FN | ||||||
Intravenous antibiotics only | 9 | 10 | 5 | 9 | P = 1 | |
Intravenous antibiotics and G-CSF | 83 | 90 | 51 | 91 | P = 1 | |
Other | 0 | 0 | 0 | 0 | P = 1 | |
Total | 92 | 100 | 56 | 100 |
Group ML (n = 185) | Group BC (n = 160) | |||||
---|---|---|---|---|---|---|
Number | % | Number | % | P-value | ||
Q. Dose of chemotherapy | ||||||
Dose reduction is not required | 143 | 77 | 49 | 31 | P < 0.001 | |
Dose reduction is required if febrile neutropenia was treated by intravenous antibiotics | 18 | 10 | 56 | 35 | P < 0.001 | |
Dose reduction is required at any rate | 22 | 12 | 55 | 34 | P < 0.001 | |
Other | 2 | 1 | 0 | 0 | P = 0.501 | |
Total | 185 | 100 | 160 | 100 | ||
Q. Antibiotics | ||||||
Antimicrobial prophylaxis deserves consideration | 67 | 36 | 42 | 26 | P = 0.049 | |
Antibiotics are taken into account on the next episode of febrile neutropenia | 91 | 49 | 95 | 59 | P = 0.065 | |
I typically don’t administer antibiotics | 27 | 15 | 23 | 14 | P = 1 | |
Other | 0 | 0 | 0 | 0 | P = 1 | |
Total | 185 | 100 | 160 | 100 | ||
Q. G-CSF | ||||||
G-CSF prophylaxis deserves consideration | 47 | 25 | 26 | 16 | P = 0.047 | |
G-CSF is taken into account when neutropenia occurs | 114 | 62 | 75 | 47 | P = 0.006 | |
G-CSF is taken into account on the next episode of febrile neutropenia | 15 | 8 | 46 | 29 | P < 0.001 | |
I typically don’t administer G-CSF | 7 | 4 | 13 | 8 | P = 0.107 | |
Other | 2 | 1 | 0 | 0 | P = 0.501 | |
Total | 185 | 100 | 160 | 100 |
Group ML (n = 185) | Group BC (n = 160) | |||||
---|---|---|---|---|---|---|
Number | % | Number | % | P-value | ||
Q. Regarding the system for managing adverse effects of outpatient chemotherapy, please check all appropriate responses | ||||||
Emergency outpatient unit is open at all hours | 159 | 86 | 112 | 70 | P < 0.001 | |
Clinical laboratory is open at all hours | 128 | 69 | 66 | 41 | P < 0.001 | |
Diagnostic imaging unit is open at all hours | 117 | 63 | 52 | 33 | P < 0.001 | |
Hospital antibiogram is available | 105 | 57 | 40 | 25 | P < 0.001 | |
Health professions provide patient and family education | 81 | 44 | 52 | 33 | P = 0.035 | |
Chemotherapy telephone helpline is available | 27 | 15 | 26 | 16 | P = 0.765 | |
Not applicable | 0 | 0 | 11 | 7 | P < 0.001 |