Impact of Developing a Filgrastim Administration Guideline on the Prevention of Febrile Neutropenia in Breast Cancer Patients at Nangrong Hospital, Buriram Province

Abstract

Background: Among breast cancer patients receiving 4AC-T and FAC chemotherapy at Nang Rong Hospital, 67.01% developed febrile neutropenia without being prescribed filgrastim for prevention. Therefore, a preventive approach was developed to increase the use of filgrastim, aiming to reduce the occurrence of febrile neutropenia and improve patient safety.

Objectives: To evaluate the effect of developing a guideline for the use of filgrastim in preventing febrile neutropenia and to assess compliance with the guideline for prescribing filgrastim in breast cancer patients.

Methods: This retrospective study was conducted in breast cancer patients receiving 4AC-T and FAC chemotherapy. Data were collected from January 1, 2021, to December 31, 2024. The incidence of febrile neutropenia before and after the development of filgrastim dosing guidelines was compared. Data were analyzed using the independent chi-square test and independent t-test.

Results: The sample groups that met the criteria before and after the guideline development included 72 patients (486 cycles) and 78 patients (467 cycles), respectively. The incidence of febrile neutropenia decreased from 2.47% to 1.50%, but this difference was not statistically significant (p-value = 0.284). However, the incidence of neutropenia decreased from 14.81% to 8.99% (p-value = 0.003), severe neutropenia decreased from 4.32% to 1.07% (p-value = 0.038), and physician compliance with the guideline increased from 32.99% to 100% (p-value < 0.001).

Conclusion: The development of filgrastim guideline has significantly reduced the severity and incidence of neutropenia. The incidence of febrile neutropenia in patients tends to decrease, promoted timely prescribing, and increased adherence rates among physicians.