临床肿瘤学医师对G-CSF使用的认识及化疗和放疗患者使用G-CSF的现状调查

A Survey of clinicians’ awareness about the use of G-CSF and the current practice of G-CSF use in cancer patients receiving chemotherapy and radiotherapy

目的:调查临床肿瘤学医师对粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)使用的认识,以及放疗和化疗患者的G-CSF使用现状,以评估临床G-CSF使用的规范性。方法:根据美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)2006年白细胞生长因子使用指南和美国国家综合癌症网(National Comprehensive Cancer Network,NCCN)2012年髓细胞生长因子指南的定义,采用自行设计的调查问卷,于2012年6月-2012年11月,对国内31家二级或三级医院的临床肿瘤学医师进行有关临床G-CSF使用认识的抽样调查,并对其中一家三级甲等医院的放疗和化疗患者使用G-CSF的现状进行调查。结果:共218名医师完成了有效问卷,其中205名完成化疗问卷,85名完成放疗问卷。对初次化疗患者进行中性粒细胞减少性发热(febrileneutropenia,FN)风险评估方面,71.4%的医师知道如何进行FN风险评估,此外分别有50.0%、62.7%和2.9%的医师明确G-CSF的一级预防性使用、二级预防性使用和治疗性使用。80.0%的医师在接受联合放化疗的患者发生中性粒细胞减少时会使用G-CSF,而不考虑放疗部位的影响。本次研究共对222名化疗患者的724次化疗进行了调查。259次(35.8%)化疗在指南未推荐预防性使用G-CSF时预防性使用了G-CSF(属于使用过度),占预防性使用G-CSF总剂量的59.7%。按照指南推荐应使用G-CSF的105次(14.5%)化疗,实际却未使用G-CSF(属于使用不足)。在治疗性使用G-CSF中,只有11次(3.1%)规范使用G-CSF,占总使用剂量的7.4%,剩余92.6%为使用过度。在35名放疗患者中,97.1%的患者在发生中性粒细胞减少时使用G-CSF;3名放疗部位包括纵隔的同步放化疗患者在发生中性粒细胞减少时均治疗性使用G-CSF,与ASCO2006年白细胞生长因子使用指南的推荐不符。绝大部分患者的G-CSF使用剂量与指南推荐的不符。结论:目前国内临床肿瘤学医师不规范使用G-CSF的比例较高,临床实践与指南推荐之间存在较大差异。临床肿瘤学医师要提高对G-CSF使用规范的认识,促进G-CSF的规范使用。

Objective： To investigate the clinicians＇ awareness about G-CSF （granulocyte colony- stimulating factor） use and the current G-CSF use in cancer patients receiving chemotherapy and radiotherapy, and evaluate the compliance with the guidelines for the use of G-CSF in the clinicians of oncology. Methods： The self-designed questionnaire based on 2006 ASCO （American Society of Clinical Oncology） and 2012 NCCN （National Comprehensive Cancer Network） guidelines for G-CSF was conducted to investigate the clinicians＇ knowledge of the use of G-CSF for cancer patients in 31 secondary/tertiary hospitals in China between June 2012 and November 2012, and a further survey of the use of G-CSF for cancer patients receiving chemotherapy and radiotherapy in a tertiary hospital was perfomed toevaluate the compliance with the guidelines. Results： Total of 218 clinicians efficiently completed the questionnaire. Of these 218 clinicians, 205 completed the questionnaire on chemotherapy and 85 on radiotherapy. For assessment of FN （febrile neutropenia） risk in patinets prior to first chemotherapy cycle, 71.4% of the clinicians were clear about this assessment; 50.0%, 62.7% and 2.9% had the knowledge about primary and secondary prophylactic use and therapeutic use of G-CSF, respectively. Approximately 80.0% of the clinicians administered G-CSF for neutropenia ocurred in patients receiving concurrent chemoradiotherapy regardless of radiation sites. There were 222 patients treated with 724 chemotherapy cycles included in the survey. In prophylactic use, 259 （35.8%） cases used G-CSF that the guideline doesn＇t recommend, which belonged to excessive use, the doses accounting for 59.7% of the totle prophylactic use; 105 （14.5%） didn＇t use while the guideline recommend, belonging to lack of use. In therapeutic use, only 3.1% were standardized, accounting for 7.4% of the total dose, and the remaining 92.6% were excessive use. Of 35 patients receiving radiotherapy, 97.1% were treated with G-CSF when neutropenia occurred; 3 patients undergoing concurrent chemoradiotherapy including mediastinum used G-CSF when neutropenia appeared, which wasn＇t in conformity with ASCO 2006 guideline. The dose of G-CSF used in majority of the patients didn＇t meet the guidelines. Conclusion： This survey indicates that the poor compliance with the recommendations of guidelines for the use of G-CSF in clinicians of oncology. There is a signifcant difference between the current clinical practice and the recommendations of guidelines. The clinicians should increase the understanding and promote the proper use of G-CSF.