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PIMSH2 – Oncology: Utilization of GCSF in Metastatic Colorectal Cancer


Measure Title: Oncology: Utilization of GCSF in Metastatic Colorectal Cancer

Measure Description Percentage of Stage 4 colon/rectal cancer patients receiving any white cell growth factors with chemotherapy

Denominator: Total number of patients with metastatic colorectal cancer receiving chemotherapy within the measurement period

Numerator: Patients ordered GCSF within 30 days following receipt of chemotherapy for metastatic colorectal cancer

Denominator Exclusions: Patients on clinical trial during measurement period or hospice services received by patient any time during the measurement period

Denominator Exceptions: None

Numerator Exclusions: None

Published Specialty: Hematology & Oncology

High Priority Measure: Yes

Measure Type: Efficiency

Include Telehealth: Yes

Inverse Measure: Yes

Proportional Measure: Yes

Continuous Variable Measure: No

Ratio Measure: No

Score Range: N/A

Number of Performance Rates: 1

Performance Rate Description: N/A

Risk Adjusted Status: No

MIPS Reporting Options: MVP, Traditional MIPS

Care Setting: Ambulatory Care: Clinician Office/Clinic

Clinical Recommendation Statement: This measure is endorsed by the US Oncology Network of Physicians. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Updates (2015). ASCO guidelines recommend using white cell stimulating factors when the risk of febrile neutropenia, secondary to a recommended chemotherapy regimen, is approximately 20 percent and equally effective treatment programs that do not require white cell stimulating factors are unavailable.
Exceptions should be made when using regimens that have a lower chance of causing febrile neutropenia if it is determined that the patient is at high risk for this complication (due to age, medical history, or disease characteristics). American Society of Clinical Oncology Ten Things Physicians and Patients Should Question. Released April 4, 2012 (1-5) and October 29, 2013 (6-10).

Measure Rationale: ASCO states that despite the widespread use of GCSFs, their use as primary prophylaxis of febrile neutropenia in the clinical setting varies widely and is inconsistent with guidelines. In the palliative setting, dose escalation has not been demonstrated to improve outcomes or quality of life.
A recent retrospective cohort study corresponding to nearly 3,000 patients also demonstrated that through greater guideline awareness and practice policy initiatives, there was a positive affect on GCSF prescription patterns and greater adherence to clinical guidelines. This resulted in a more cost-effective approach for patients with metastatic colorectal cancer without affecting mortality rates. JCO Oncology Practice 17, no. 11 (November 01, 2021) e1830-e1836.

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