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. 2022 Nov;30(11):9181-9189.
doi: 10.1007/s00520-022-07343-5. Epub 2022 Aug 31.

Real-world evaluation of supportive care using an electronic health record text-mining tool: G-CSF use in breast cancer patients

Sylvia A van Laar  1 , Kim B Gombert-Handoko  1 , Sophie Wassenaar  1 , Judith R Kroep  2 , Henk-Jan Guchelaar  1 , Juliette Zwaveling  3
Affiliations

Real-world evaluation of supportive care using an electronic health record text-mining tool: G-CSF use in breast cancer patients

Sylvia A van Laar et al. Support Care Cancer. 2022 Nov.

Abstract

Purpose: Chemotherapy-induced febrile neutropenia (FN) is a life-threatening and chemotherapy dose-limiting adverse event. FN can be prevented with granulocyte-colony stimulating factors (G-CSFs). Guidelines recommend primary G-CSF use for patients receiving either high (> 20%) FN risk (HR) chemotherapy, or intermediate (10-20%) FN risk (IR) chemotherapy if the overall risk with additional patient-related risk factors exceeds 20%. In this study, we applied an EHR text-mining tool for real-world G-CSF treatment evaluation in breast cancer patients.

Methods: Breast cancer patients receiving IR or HR chemotherapy treatments between January 2015 and February 2021 at LUMC, the Netherlands, were included. We retrospectively collected data from EHR with a text-mining tool and assessed G-CSF use, risk factors, and the FN and neutropenia (grades 3-4) and incidence.

Results: A total of 190 female patients were included, who received 77 HR and 113 IR treatments. In 88.3% of the HR regimens, G-CSF was administered; 7.3% of these patients developed FN vs. 33.3% without G-CSF. Although most IR regimen patients had ≥ 2 risk factors, only 4% received G-CSF, of which none developed neutropenia. However, without G-CSF, 11.9% developed FN and 31.2% severe neutropenia.

Conclusions: Our text-mining study shows high G-CSF use among HR regimen patients, and low use among IR regimen patients, although most had ≥ 2 risk factors. Therefore, current practice is not completely in accordance with the guidelines. This shows the need for increased awareness and clarity regarding risk factors. Also, text-mining can effectively be implemented for the evaluation of patient care.

Keywords: Breast cancer; Chemotherapy-induced febrile neutropenia; Clinical practice pattern; Granulocyte-colony stimulating factor; Text-mining.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Proportion of patients that received primary granulocyte-colony stimulating factor (PP G-CSF) treatment and developed neutropenia (≥ grade 3) or febrile neutropenia stratified for intermediate- and high-risk chemotherapy treatments
Fig. 2
Fig. 2
Number of confirmed risk factors per patient in the intermediate risk group stratified by G-CSF use (A), and patients not receiving PP G-CSF by FN status (B)
See this image and copyright information in PMC

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