An audit of neutropenic complications in
breast cancer patients receiving adjuvant or
neo-adjuvant chemotherapy with FEC-D in
the West of Scotland (WoS)
Clair Clark, Cancer Care Pharmacist
Introduction
• Background
• Aims and Objectives
• Criteria and Standards
• Methodology
• Results
• Limitations
Background
1.
Aaprol, M.S., Cameron D.A. et al (2006) “EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy induced febrile neutropenia in adult
patients with lymphomas and solid tumours” European Journal of Cancer 42: 15: pp 2433-2453
2.
Smith, T.J., Khatcheressian, J. et al (2006) “2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline” Journal of Clincal
Oncology 24: 19: pp 3187-3205
3.
Fraser, J., Steele, N. et al (2010) Non trial experience of FEC-D chemotherapy in node positive breast cancer patients and associated toxicity
4.
Roche, H., Fumoleau, P. et al (2006) “Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial” Journal of Clinical
Oncology, 24: 36: pp 5564-5671
5.
O’Connor, P. (2010) A study of the haematological tolerability of FEC-D as adjuvant chemotherapy treatment of early breast cancer in the West of Scotland, MSc in Clinical Pharmacy, The Robert
Aims and Objectives
Aim
• To monitor the rate of significant neutropenic
events in breast cancer patients receiving
adjuvant or neo-adjuvant chemotherapy with
FEC-D, following amendment of protocol to
remove GCSF for primary prophylaxis for
Aims and Objectives
Objectives
To determine;
• The incidence of neutropenic complications in patients
receiving FEC-D chemotherapy
• The proportion of patients receiving GCSF as primary
prophylaxis with FEC phase of FEC-D
• The indication for primary prophylaxis with GCSF during FEC
• The proportion of patients receiving GCSF as secondary
prophylaxis
• The GCSF preparation prescribed and dose / duration / start
date of GCSF
Criteria
Standard Exceptions
1. During FEC phase of FEC-D treatment;
patients will not receive GCSF for primary
prophylaxis of neutropenia (defined as
neutrophil count <1)
100%
Patients with additional risk
factors for developing
neutropenia as defined by the
WoSCAN GCSF policy.
2. Patients will not have a delay in treatment
of > 7 days as a result of a neutropenic
event (neuts.<1) during FEC phase
80%
3. Patients will not have a delay in treatment
of > 7 days as a result of a neutropenic
event (neuts.<1) during D phase
90%
4. During treatment patients receiving GCSF
will not develop neutropenic sepsis
(neuts.<1 and temp > 38.5
o
C)
90%
5. Patients will only be prescribed GCSF for
secondary prophylaxis following a
neutropenic event
100%
Patients who develop additional
risk factors as defined in primary
prophylaxis GCSF guidelines.
An audit of neutropenic complications in breast cancer patients receiving
adjuvant/ neo-adjuvant* chemotherapy with FEC-D** in the West of Scotland
* Please mark if patient receiving Adjuvant or Neo-Adjuvant treatment
**Fluorouracil 500mg/m2
Epirubicin 100mg/m2
Cyclophosphamide 500mg/m2
every 21 days for 3 cycles followed by Docetaxel
100mg/m2
every 21 days for 3 cycles
Please return completed forms to: J Laskey, Pharmacy Department, Beatson West of Scotland cancer Centre Page 1 of 2
Section 1: Patient / Hospital details
Patient identifier: Weight (kg):
Hospital site (please tick): Ayr BWOSCC CrossH Forth valley Hairmyres InverC Monks NVH RAH Wishaw VoL
Section 2: Therapy Details
Cycle 1 FEC Cycle 2 FEC Cycle 3 FEC
Date
2.1a Has full dose been
prescribed as per footnote? If ‘YES’ go to question 2.2 YES / NO If ‘YES’ go to question 2.2 YES / NO If ‘YES’ go to question 2.2 YES / NO 2.1b What dose was
prescribed? Dose: ………. Dose: ………. Dose: ………. 2.2 Has GCSF been prescribed as primary prophylaxis? YES / NO YES / NO If ‘No’ go to question 2.4 YES / NO If ‘No’ go to question 2.4 2.3 Reason for primary
prophylaxis?
Pre-existing neutropenia Poor performance status Open wound Tissue infection Other, please state ________________
Pre-existing neutropenia Poor performance status Open wound Tissue infection Other, please state ________________
Pre-existing neutropenia Poor performance status Open wound Tissue infection Other, please state ________________ 2.4 Neutropenic sepsis
since last cycle?
i.e. neuts < 1.0 and temp ≥ 38.5◦C
N/A YES / NO YES / NO 2.5 Delay of ≥ 7 days in
chemo due to neutrophils < 1?
N/A YES / NO YES / NO 2.6 Has GCSF been
prescribed as secondary
prophylaxis?
N/A YES / NO If ‘Yes’ please state reason: Neut sepsis Neut delay Other:_____________
YES / NO If ‘Yes’ please state reason: Neut sepsis Neut delay Other:____________ 2.7 Dose of GCSF prescribed? Filgrastim 300mcg Filgrastim 480mcg Pegfilgrastim 6mg Other___________ Filgrastim 300mcg Filgrastim 480mcg Pegfilgrastim 6 mg Other ____________ Filgrastim 300mcg Filgrastim 480mcg Pegfilgrastim 6mg Other ____________ 2.8 Duration of GCSF? One dose
5 days 7 days 10 days Other __________ One dose 5 days 7 days 10 days Other __________ One dose 5 days 7 days 10 days Other __________ 2.9 Start day? Day 2
Day 3 Day 5 Other ___________ Day 2 Day 3 Day 5 Other ___________ Day 2 Day 3 Day 5 Other ___________
