Clinical pathways have been suggested as a good method to implement guidelines into clinical practice and to reduce treatment variability. Although oncology clinical pathways have been studied previously, a new study looked at supportive care services and their effect on reducing emergency department visits and hospitalizations associated with chemotherapy toxicities (Kreys ED, et al. J Oncol Pract. 2014;10:168-173).
This retrospective cohort study analyzed the effects of compliance to cancer supportive care pathways on emergency department visits and hospitalizations associated with neutropenia, anemia, and chemotherapy-induced nausea and vomiting (CINV). Pathways for supportive care services encompassed the utilization of granulocyte colony-stimulating factors (G-CSFs), erythrocyte-stimulating agents (ESAs), and antiemetics.
The evaluated data, spanning the initial 2 years of the Cardinal Health Specialty Solutions and the CareFirst BlueCross BlueShield multistate oncology clinical pathways program, were obtained from the CareFirst claims database.
A total of 3191 patients from 46 practice sites across 3 states received 4144 lines of therapy. Of these patients, 51% received treatments for breast cancer, 27% for lung cancer, and 22% for colorectal cancer. Among the chemotherapy regimens, 28% were potentially at high risk for causing febrile neutropenia; 56% of the regimens included cisplatin (Platinol), oxaliplatin (Eloxatin), cyclophosphamide (Cytoxan), or carboplatin (Paraplatin). Overall, 472 emergency department visits/hospitalizations were reported for neutropenia, 34 visits for anemia, and 799 visits for CINV.
Compliance with the G-CSF pathway was associated with a significant reduction in neutropenia emergency department visits/hospitalizations compared with pathway noncompliant treatment (10.5% vs 25.9%, respectively; odds ratio [OR], 0.34; 95% confidence interval [CI], 0.25-0.45; P <.001).
Compliance with ESAs and antiemetic medication was not associated with significant differences in corresponding emergency department visits/hospitalizations for anemia. When adjusting for cancer type and G-CSF drug expenditure, a similar reduction was observed in neutropenia-related emergency department visits/hospitalizations (OR, 0.42; 95% CI, 0.30-0.58; P <.001). However, the adjustment did not greatly alter the results when applied to analogous comparisons of ESAs or antiemetics.
The total expenditures for emergency department visits/hospitalizations as a result of neutropenia, anemia, and CINV were $2.8 million, $0.1 million, and $3.6 million, respectively, resulting in average expenditures of $687, $34, and $877, respectively, per line of therapy.
Compliance with G-CSF therapy was also associated with an average decrease of $1085 in emergency department visit/hospitalization costs per line of therapy, whereas ESA and antiemetic medication compliance was associated with average cost increases of $60 and $7, respectively, per line of therapy.
This study underscores the importance of adhering to evidence-based medicine to prevent adverse events of chemotherapy and to optimize treatment for cancer as a whole. The analysis appears to demonstrate an association between pathway compliance for the use of G-CSFs and a reduction in emergency department visits/hospitalizations resulting from neutropenia. Although this association cannot be made regarding ESAs or antiemetics, the researchers suggest that studies that incorporate more comprehensive clinical data would be valuable. They also recommend further study of the implications of adherence to guidelines for supportive care.
