Clinical Pathways for Myeloid Growth Factors Lead to Appropriate Use


A poster presentation at Academy of Managed Care Pharmacy (AMCP) Nexus 2017 found that the implementation of a clinical pathway increased the appropriate use of myeloid growth factors for patients receiving myelosuppressive cancer chemotherapy.

The researchers explained that use of myeloid growth factors is essential to prevent major toxicities in certain patients who receive myelosuppressive chemotherapy for cancers such as leukemia.

“Myelosuppressive cancer chemotherapy leads to major toxicities including febrile neutropenia and infection,” Andrew Hertler, MD, chief medical officer at New Century Health, and colleagues wrote. “In the curative setting, prophylactic use of myeloid growth factors is recommended when the risk of febrile neutropenia is greater than 20% and no other equally effective and safe regimen is available. In the palliative setting, myeloid growth factor use can be avoided by dose reduction or delay. myeloid growth factors should also not be routinely used for patients with neutropenia without fever.”

Dr Hertler and colleagues studied a clinical pathway that was created by New Century Health care in conjunction with oncologists in order to increase the quality of care associated with use of myeloid growth factors. In order to measure the impact of the clinical pathway, the researchers compared the amount of consultative requests received 1 year before the pathway’s implementation to requests after its implementation. They used this data to gauge the pathway’s impact on the number of withdraws/recommended adverse determinations and cost-savings.


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Study results showed that there was a significant difference in both of the outcomes measured. They found that there was an increase in withdraws/recommended adverse determinations, with percentages increasing from 7.5% to 20.2% in Florida and 12.7% to 30.2% in Arizona—the two states studied. Likewise they found an increase in cost-savings in both states associated with the clinical interventions.

“The implementation of a clinical pathway, with consultative support, aided in proper usage of myeloid growth factors through provider education and resulted in potential cost-savings,” Dr Hertler and colleagues concluded. “This analysis further supports the benefit of pathway integrated guidelines applied in community practice settings.”—David Costill