Liu, F., Du, Y., Cai, B., Yan, M., Yang, W., & Wang, Q. (2017). A clinical study of polyethylene glycol recombinant human granulocyte colony-stimulating factor prevention neutropenia syndrome in patients with esophageal carcinoma and lung cancer after concurrent chemoradiotherapy. Journal of Cancer Research and Therapeutics, 13, 790–795.

To compare the efficacy and safety of PEG-rhG-CSF (prevention cohort) and rhG-CSF (delayed therapy cohort) for febrile neutropenia and, therefore, hospitalization of concurrent chemoradiation treatment of esophageal carcinoma and patients with lung cancer

Prophylactic application: G-CSF administered 24 hours after chemotherapy completion, 100 μg/mg PEG-rhG-CSF subcutaneously injected, whereas 150 μg of rhG-CSF was subcutaneously injected; the injection was performed once daily until leukocytes >10×10⁹. Delayed application: G-CSF administered 5 days after the completion of chemotherapy.

• N = 163   
• AGE: 18-65 years
• MALES (%): not stated  
• FEMALES (%): not stated
• CURRENT TREATMENT: Combination radiation and chemotherapy
• KEY DISEASE CHARACTERISTICS: Locally advanced esophageal carcinoma, non-surgical candidates, and patients with lung cancer endured induction plus concurrent chemoradiotherapy
• OTHER KEY SAMPLE CHARACTERISTICS: KPS score of 90 points or greater; patients without serious complications; ANC ≥ 1.5; plt ct ≥ 100; Exclusions were patients with bone metastasis or bone marrow metastasis; ALT/AST ≥ 1.5 (ULN) and combined with ALK PO4 ≥ 2.5 (ULN) or bili > 2 (ULN) or creatinine > 1.5 (ULN); or patients with histories of chemoradiotherapy or radiotherapy systemically; unmanageable infection

• SITE: Multi-site   
• SETTING TYPE: Multiple settings    
• LOCATION: China

• PHASE OF CARE: Active anti-tumor treatment
• APPLICATIONS: Adult care

Active treatment study for neutropenia-related hospitalizations for patients receiving concurrent chemoradiotherapy

SPSS, version 22.0, software (α = 0.05)

Comparison between the prevention group and the delayed group showed that the incidence of neutropenia-related hospitalizations were 4.44% and 14.62%, respectively (OR = 0.272, 95% CI [0.115, 0.642], p = 0.002). Comparison between the prevention group and the delayed group showed that the incidence of febrile neutropenia was 5.56% and 18.46%, respectively (OR = 0.26, 95% CI [0.12, 0.565], p = 0.001).

Prophylactic use of GCF decreased hospitalization rates and the use of IV antibiotics.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)

Nursing would teach effects of chemotherapy and depletion of white cells which could lead to hospitalizations and neutropenic fever. Administering this medication prophylactically would ensure less hospitalizations and less severe fevers as well as decrease use of antibiotics.