Fernandes, R., Mazzarello, S., Stober, C., Vandermeer, L., Dudani, S., Ibrahim, M.F., . . . Clemons, M. (2016). Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: A systematic review. Breast Cancer Research and Treatment, 161, 1–10.

DOI Link

Purpose

STUDY PURPOSE: To determine whether colony-stimulating factors or antibiotic prophylaxis are optimal choices for the prevention of febrile neutropenia in patients receiving docetaxel-cyclophosphamide chemotherapy

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: Embase, Medline, PubMed, and Cochrane Collaboration
 
INCLUSION CRITERIA: Patients receiving DC chemotherapy for breast cancer in the adjuvant or neoadjuvant setting, receiving colony-stimulating factors and antibiotics with comparators of prophylactic antibiotics or best supportive care 
 
EXCLUSION CRITERIA: None specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,200
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Collaboration risk of bias assessment; one study had high risk, and two had unclear risk of bias; 11 studies were retrospective, and 3 were abstracts only.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 
  • TOTAL PATIENTS INCLUDED IN REVIEW = 2,535
  • SAMPLE RANGE ACROSS STUDIES: 30–982

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Results

Hospital admission because of febrile neutropenia (FN) occurred in a median of 13% of patients, and 7.5%, on average, had delays in chemotherapy because of FN. DC chemotherapy was associated with median FN rates of 6.6% with and 31.3% without primary prophylaxis.

Conclusions

FN prophylaxis was associated with lower FN rates; however, the study results could not differentiate the efficacy of antibiotics versus colony-stimulating factors.

Limitations

  • Limited search
  • Mostly low quality/high risk of bias studies
  • Most studies were retrospective.

Nursing Implications

Patients receiving DC chemotherapy benefit from primary FN prophylaxis. Insufficient evidence exists to determine the comparative efficacy of prophylaxis with antibiotics versus colony-stimulating factors.

Legacy ID

6417