Interdisciplinary Patient Pathway Department, Gustave Roussy, Villejuif, France.
Gastrointestinal Oncology Department, Hôpital Jean Mermoz, Lyon, France.
Support Care Cancer. 2024 May 14;32(6):347. doi: 10.1007/s00520-024-08524-0.
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.
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).
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.
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.
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。
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)。
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。
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。