Effects of primary prophylaxis of neutropenia on outcomes, utilization and expenditures for elderly breast cancer patients receiving chemotherapy

Systemic chemotherapy is a well-established primary as well as adjuvant therapy for breast cancer, and is highly successful in ensuring recurrence free survival among patients. However, toxicity due to chemotherapy, specifically an early onset hematologic toxicity called neutropenia, restricts the use and therefore the efficacy of chemotherapy in breast cancer patients, especially in the elderly. The prophylactic use of granulocyte-colony stimulating factors (G-CSF), helps prevent neutropenia, improves the tolerance of chemotherapy in the elderly, and improves the prognosis of breast cancer. Nevertheless, evidence supporting the clinical and cost effectiveness of prophylactic G-CSF in the elderly is limited, and thus the American Society of Clinical Oncology (ASCO) guidelines for use of prophylactic G-CSF in the elderly are not explicit. This study aims to assess the effect of primary prophylactic G-CSF on - the occurrence of chemotherapy-induced neutropenia hospitalization and length of stay; Medicare expenditures due to neutropenia management; overall expenditures in the first year after the start of chemotherapy; and successful administration of systemic cancer therapies that are otherwise hindered by the occurrence of neutropenia, in elderly breast cancer patients receiving chemotherapy. The study found that primary prophylactic G-CSF reduced the probability of neutropenia hospitalization and improved the provision of systemic chemotherapy and radiation therapy during the first course of the treatment in elderly breast cancer patients. The study also found that duration of primary prophylactic G-CSF administration was significantly associated with better outcomes, with lower rates of neutropenia hospitalization and better adherence to systemic cancer therapies. These findings have implications for ASCO guidelines and Medicare coverage policies for G-CSF administration and duration of administration in elderly breast cancer patients