Use of Filgrastim Among Febrile Inpatients Who Received Outpatient Filgrastim or Pegfilgrastim

Purpose: To characterize the inpatient use of filgrastim in cancer patients hospitalized for management of post-chemotherapy fever after receiving either outpatient filgrastim or pegfilgrastim. Method: Retrospective review of chart records in a single-center, tertiary- care, teaching hospital and outpatient oncology center of cancer patients hospitalized for fever after outpatient chemotherapy and proactive administration of filgrastim or pegfilgrastim. Patients with the following tumor types were included: breast cancer, cervical cancer, colon cancer, Hodgkin disease, intermediate- or high-grade non-Hodgkin lymphoma, small cell or non-small cell lung cancer, and ovarian cancer. Result: Billing data identified 1,438 outpatient chemotherapy patients treated with filgrastim or pegfilgrastim; 261 (18.2%) of whom were hos- pitalized for fever. All patients in the filgrastim groups, and 78% of those in the pegfilgrastim group, were given inpatient filgrastim. Duration of filgrastim administration in the inpatient setting was significantly shorter (P < 0.001) for the pegfilgrastim group. Conclusions: Filgrastim was frequently administered to cancer patients hospitalized for fever, even after outpatient pegfilgrastim was adminis- tered as an adjunct to chemotherapy. Patients treated with once-per-cycle pegfilgrastim in an outpatient setting do not require filgrastim if they are hospitalized for fever before neutrophil recovery. Thus, hospitals could realize immediate cost savings by not treating those patients with filgras- tim. This study illustrates the need to develop operational procedures in institutions to rapidly identify prior outpatient pegfilgrastim administra- tion as a patient is admitted for post-chemotherapy fever.