{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:46:15Z","timestamp":1791359175389,"version":"4.3.1"},"reference-count":15,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2023,1,20]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Primary prophylactic colony-stimulating factors (PP-CSFs) are prescribed to reduce febrile neutropenia (FN) but their benefit for intermediate FN risk regimens is uncertain. Within a pragmatic, randomized trial of a standing order entry (SOE) PP-CSF intervention, we conducted a substudy to evaluate the effectiveness of SOE for patients receiving intermediate-risk regimens. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> TrACER was a cluster randomized trial where practices were randomized to usual care or a guideline-based SOE intervention. In the primary study, sites were randomized 3:1 to SOE of automated PP-CSF orders for high FN risk regimens and alerts against PP-CSF use for low-risk regimens versus usual care. A secondary 1:1 randomization assigned 24 intervention sites to either SOE to prescribe or an alert to not prescribe PP-CSF for intermediate-risk regimens. Clinicians were allowed to over-ride the SOE. Patients with breast, colorectal, or non\u2013small-cell lung cancer were enrolled. Mixed-effect logistic regression models were used to test differences between randomized sites. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> Between January 2016 and April 2020, 846 eligible patients receiving intermediate-risk regimens were registered to either SOE to prescribe (12 sites: n = 542) or an alert to not prescribe PP-CSF (12 sites: n = 304). Rates of PP-CSF use were higher among sites randomized to SOE (37.1% v 9.9%, odds ratio, 5.91; 95% CI, 1.77 to 19.70; P = .0038). Rates of FN were low and identical between arms (3.7% v 3.7%). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> Although implementation of a SOE intervention for PP-CSF significantly increased PP-CSF use among patients receiving first-line intermediate-risk regimens, FN rates were low and did not differ between arms. Although this guideline-informed SOE influenced prescribing, the results suggest that neither SOE nor PP-CSF provides sufficient benefit to justify their use for all patients receiving first-line intermediate-risk regimens. <\/jats:p><\/jats:sec>","DOI":"10.1200\/jco.22.01258","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T19:59:20Z","timestamp":1665691160000},"page":"590-598","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":5,"title":["A Pragmatic Cluster-Randomized Trial of a Standing Order Entry Intervention for Colony-Stimulating Factor Use Among Patients at Intermediate Risk for Febrile Neutropenia"],"prefix":"10.1200","volume":"41","clinical-trial-number":[{"clinical-trial-number":"nct02728596","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8807-153X","authenticated-orcid":false,"given":"Dawn 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WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-7179","authenticated-orcid":false,"given":"Kathryn B.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center, Seattle, WA"},{"name":"SWOG Statistics and Data Management Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Watabayashi","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari","family":"Bell-Brown","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyet A.","family":"Le-Lindqwister","sequence":"additional","affiliation":[{"name":"Illinois CancerCare\u2014Peoria (Heartland Cancer Research NCORP), Peoria, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie L.","family":"Dul","sequence":"additional","affiliation":[{"name":"Ascension Saint John Hospital (Michigan Cancer Research Consortium NCORP), Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ursa A.","family":"Brown-Glaberman","sequence":"additional","affiliation":[{"name":"University of New Mexico Cancer Center (New Mexico Minority Underserved NCORP), Albuquerque, NM"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0223-4076","authenticated-orcid":false,"given":"Robert J.","family":"Behrens","sequence":"additional","affiliation":[{"name":"Med Onc & Hem Assoc-Des Moines (Iowa-Wide Oncology Research Coalition NCORP), Des Moines, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Vogel","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center (Geisinger Cancer Institute NCORP), Danville, 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