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利用 G-CSF 在门诊环境中的处方:超越临床因素的考虑因素——问卷调查研究。

Leveraging G-CSF prescribing in the outpatient setting: considerations beyond clinical factors-a questionnaire study.

机构信息

Interdisciplinary Patient Pathway Department, Gustave Roussy, Villejuif, France.

Gastrointestinal Oncology Department, Hôpital Jean Mermoz, Lyon, France.

出版信息

Support Care Cancer. 2024 May 14;32(6):347. doi: 10.1007/s00520-024-08524-0.

Abstract

PURPOSE

This study aims to delineate G-CSF treatment practices, assess decision criteria, and measure their implementation in ambulatory settings for patients with breast (BC), lung (LC), or gastrointestinal cancers (GIC), beyond standard recommendations.

METHODS

In this non-interventional, cross-sectional, multicenter study, clinical cases were presented using conversational interfaces (chatbots), simulating a conversation with one or more virtual interlocutors through voice or text exchange. The clinical simulations were configured by four parameters: types of cancer, risk of FN related to chemotherapy and comorbidities, access to care, and therapy setting (adjuvant/neoadjuvant/metastatic).

RESULTS

The questionnaire was completed by 102 physicians. Most practitioners (84.5%) reported prescribing G-CSF, regardless of tumor type. G-CSF was prescribed more frequently for adjuvant/neoadjuvant therapy than for metastatic cases. The type of chemotherapy was cited as the first reason for prescribing G-CSF, with access to care being the second. Regarding the type of chemotherapy, physicians do not consider this factor alone, but combined with comorbidities and age (56.7% of cases). Pegfilgrastim long-acting was prescribed in most cases of BC and LC (70.1% and 86%, respectively), while filgrastim short-acting was named in the majority of cases of GIC (61.7%); 76.3% of physicians prescribed G-CSF as primary prophylaxis.

CONCLUSIONS

Our findings suggest that recommended practices are broadly followed. In the majority of cases, G-CSF is prescribed as primary prophylaxis. In addition, physicians seem more inclined to prescribe G-CSF to adjuvant/neoadjuvant patients rather than metastatic patients. Finally, the type of chemotherapy tends to be a more significant determining factor than the patient's background.

摘要

目的

本研究旨在描述超出标准推荐方案之外,在门诊环境中使用 G-CSF 治疗乳腺癌(BC)、肺癌(LC)或胃肠道癌症(GIC)患者的治疗实践、评估决策标准,并衡量其实施情况。

方法

在这项非干预性、横断面、多中心研究中,使用对话界面(聊天机器人)呈现临床病例,通过语音或文本交换与一个或多个虚拟对话者进行对话模拟。临床模拟通过四个参数进行配置:癌症类型、与化疗相关的 FN 风险和合并症、获得治疗的途径以及治疗环境(辅助/新辅助/转移性)。

结果

102 名医生完成了问卷。大多数医生(84.5%)报告了无论肿瘤类型均开具 G-CSF。辅助/新辅助治疗比转移性病例更频繁地开具 G-CSF。开具 G-CSF 的首要原因是化疗类型,其次是获得治疗的途径。关于化疗类型,医生不单独考虑这一因素,而是将其与合并症和年龄相结合(56.7%的病例)。在 BC 和 LC 的大多数情况下,长效培非格司亭(pegfilgrastim long-acting)被开具(分别为 70.1%和 86%),而在 GIC 的大多数情况下,短时效粒系集落刺激因子(filgrastim short-acting)被开具(61.7%);76.3%的医生将 G-CSF 作为初级预防药物开具。

结论

我们的研究结果表明,推荐的实践得到了广泛遵循。在大多数情况下,G-CSF 被作为初级预防药物开具。此外,医生似乎更倾向于为辅助/新辅助患者而非转移性患者开具 G-CSF。最后,化疗类型往往是一个比患者背景更重要的决定因素。

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