JCO: A Way Forward on the Medically Appropriate Use of White Cell Growth Factors (hematopoietic colony-stimulating factors (CSFs))

A Way Forward on the Medically Appropriate Use of White Cell Growth Factors

Discussion points:

• Are Hematopoietic Colony-Stimulating Factors Over- or Underused?
• Table 1. Comparison of Major Guidelines
• How Can These Disparate Conclusions Be Reconciled?
• CSFs for Dose Maintenance in Routine Noncurative Cancer Care
• CSFs Used to Treat FN or Afebrile Neutropenia
• What Is the Harm in Using CSFs?
• Are CSFs a Prudent Use of Societal Resources?
• Why Do Oncologists Prescribe CSFs if There Is Minimal Evidence for Benefit?
• How Did We Arrive at Widespread Use Without Clinical Trial Justification?
• The Way Forward to Evidence-Based Use of CSFs
• Disclosures/REFERENCES

"There are concrete steps the US oncology community can take to foster more evidence-based care. The Quality Oncology Practice Initiative⁵¹ could add overuse as a quality criterion⁵² and report CSF use in palliative-intent regimens when there is less than a 20% risk of FN. The major guideline groups (European Organisation for Research and Treatment of Cancer,⁶ National Comprehensive Cancer Network,⁵ and ASCO⁴) should endorse dose modification as an equally appropriate and preferred strategy in the absence of proven benefit. "