Chemotherapy-induced neutropenia (CIN) is a common and potentially life-threatening consequence of chemotherapy, as it may lead to serious infections for patients with cancer. These infections result in hospital stays, increased morbidity and mortality, and considerable financial burden. In this interview, Dr. Maura Abbott explains the importance of managing and educating patients about CIN.
Oncology Data Advisor: Welcome to Oncology Data Advisor, I am Lyn Brook. Today I am here with Dr. Maura Abbott, Assistant Dean of Clinical Affairs at the Columbia University School of Nursing. She recently co-led a continuing medical education (CME) and nurse continuing professional development (NCPD) activity, New Insights into Preventing and Managing Chemotherapy-Induced Neutropenia. This activity is available on our medical education website, i3Health.com, for free CME/NCPD credit, and will be linked in the text box below.
Dr. Abbott, would you like to first start out with a bit of an introduction about yourself and your interests?
Maura Abbott, NP, MSN, PhD: Sure. I am Maura Abbott. I am an Assistant Dean for Clinical Affairs and Associate Professor of Nursing and the Oncologist Health Specialty Program Director at the Columbia University School of Nursing. I am also a Practicing Oncology Nurse Practitioner, and I run the Oncology Urgent Care at Columbia University Irving Medical Center. And my interests are really just making sure patients are able to get their treatments and have the best prognosis and the best outcomes, and that side effects are managed along the way of their treatment in their diseases.
Oncology Data Advisor: Right and thank you so much for your time again today.
Dr. Abbott: Sure, glad to be here.
Oncology Data Advisor: First question I have for you is, why do you feel it's important that health care professionals participate in this activity and address their knowledge gaps about chemotherapy-induced neutropenia?
Dr. Abbott: So, chemotherapy-induced neutropenia, and when then you couple it along with febrile neutropenia, is one of the biggest reasons that patients have to undergo dose reductions or treatment delays. And we know that after a certain amount of times with treatment delays and/or dose reductions, the prognosis changes for the patients. I think it's really important that providers understand what the current landscape of chemotherapy-induced neutropenia is and what is out there for treatment, what the guidelines are for prevention, and when we can do so, because it is a preventable cause of mortality. And I think that's really important part.
There are also things that are coming down the pipe, and there are new things all the time. I think we assume that we know what we're doing all the time, but there are new things, and to keep on top of what's new, I think it's important to take part in this activity so we can prevent any negative outcomes for our patients and improve the positive outcomes for our patients who are undergoing treatment and may be at risk for chemotherapy-induced neutropenia.
I think it's really important that patients are educated so that they know what to look for and feel really comfortable reaching out to us any time day or night with any questions, to have their best chance of best outcomes."by Author
Oncology Data Advisor: And why is it necessary that health care professionals educate their patients about CIN and febrile neutropenia risk factors and prevention?
Dr. Abbott: I think that's similar to the first answer. We, as health care providers, need to know who's at risk so we can effectively prevent that risk and/or be as quick and reactive as we can because, unfortunately, treatments for febrile neutropenia and chemotherapy-induced neutropenia are, at this point, mostly reactive. I think it's really important that our patients also know what to look for in terms of signs and symptoms of both of these phenomena, so that they can understand the potential seriousness of these conditions, that they know what to do if they experience a fever and they're potentially neutropenic, and how important it is to get medical help in an emergent and urgent fashion. Knowing that it could be life threatening is really, really important, and that we want to go ahead and try to prevent it from happening or treat it as quickly as possible, again, so that patients have the best outcomes and so that we can potentially reduce hospitalizations or length of hospitalizations for patients who need it the earlier we're able to go ahead and treat it.
I think it's really important for patients to understand that they're never bothering us or anything like that, because patients are always worried that they're calling at midnight on Christmas. It doesn't matter. We want patients to understand that we're there for them and this is really important and to call any time of the day or night, if they're not feeling well, if they're at risk for neutropenia, or if they may or may not have a fever. People think, "Oh, I must have a fever to be sick," and they may not be neutropenic and have chills. So, I think it's really important that patients are educated so that they know what to look for and feel really comfortable reaching out to us any time day or night with any questions, to have their best chance of best outcomes, which is, again, what we're looking for. We're looking for patients to survive as long as possible and/or be cured when possible and do well.
Oncology Data Advisor: I really enjoyed the patient perspective of the activity. I thought it's so important to include that, so thank you for that.
Dr. Abbott: Yes, of course.
Oncology Data Advisor: And what would you like to see done in the next few years regarding the advancement of alternative strategies for preventing and managing CIN?
Dr. Abbott: As I mentioned a little bit earlier, right now our focus is on being reactive when it happens. It's only in a small amount of cases where we're prophylactically giving some sort of granulocyte colony stimulating factor to hopefully prevent it in patients. We do that with patients who have liquid tumors, like leukemia patients or myelodysplastic syndromes (MDS) patients or lymphoma patients, but we don't necessarily do that in patients who have solid tumors who are getting highly myelosuppressive chemotherapeutic agents for treatment. And so, we end up being reactive after Cycle 1, which is where we see this happen most frequently.
So, what I would love to see is to move away from reactive and figure out a way for us to become proactive. And unfortunately, one of the biggest hindrances to that is the cost of these medications and insurance coverage for patients. These can be thousands and thousands and thousands of dollars, tens of thousands of dollars, per injection, and unless you're really independently wealthy, this is not something that most patients can afford. It would be nice if we could figure out a way to make these medications more accessible in terms of affordability and figure out some evidence to show that perhaps a larger group of people should be getting them prophylactically.
I think also coming down the pipe, we're also looking at different medications, different classes of drugs, and I'm thinking about the CDK4 and 6 inhibitors. Trilaciclib is the medication, and that's one of the ones we can think about giving that can prevent chemotherapy-induced neutropenia. And plinabulin is another drug that's being studied and hopefully can prevent it, so perhaps we can focus on that as well. When those drugs are available, hopefully they can be truly accessible, not just available. Potentially we could prevent this from happening and maybe even prevent delays or dose reductions or any of those kinds of things, and that would be amazing for patients. Maybe we could prevent people from having to go in the hospital for febrile neutropenia.
The other thing I think really would be great is to get more evidence on who really needs to be in the hospital and who doesn't. I think we're still moving towards being comfortable with managing some people with febrile neutropenia in the outpatient world. It's uncomfortable for us as providers, because we're used to just admitting everybody who has febrile neutropenia, where that may not be necessary as we now know. And so, patients remain stable at home on oral antibiotic therapy after they've gotten some intravenous (IV) therapies. They could be okay. It would be nice if we could figure out a little bit more about who potentially could fit into that category instead of needing a hospital admission.Those are the things that I think would be great to get to.
Oncology Data Advisor: Yeah, definitely. And I know you were mentioning some of the possible medications. I was wondering if there are any specific clinical trials you're keeping an eye on currently that could make big changes in prevention?
Dr. Abbott: Right, so those two medications that I actually mentioned, there are still ongoing clinical trials related to both of those, and I think those are ones that we're really looking at as the ones that are producing evidence that are going to impact us in the near future, as opposed to the long-term future. And I think those classes of drugs are the ones that we really need to focus on coming up in the near future.
Even if we think we know what we're up to date on, it's really important to participate in these types of activities."by Author
Oncology Data Advisor: Last question I have for you is, since recording, is there anything that you've learned or experienced that you'd like to add on to the information about CIN that you would like health care professionals to know?
Dr. Abbott: It's interesting that you ask that because I think that when I was recording the activity, I was pretty sure I knew everything about it—I do it every single day in practice—but I think Dr. Lyman and I each learned from each other when we were recording the initial presentation on this, because we each focus on different parts: the patient perspective, the scientific perspective, the clinical perspective. There are all these pieces, and I think what I have learned, and I think what's really important is, even if we think we know what we're up to date on, it's really important to participate in these types of activities, because I think they bring forward some of the stuff that we may not have actually. It may be very nuanced, but it may be something that we haven't yet put into our team, even if we are aware of it, and I think that's really, really important. And again, I think I've become more comfortable about who I can manage at home versus who I need to admit to the hospital, and I think that's a really big thing for our patients. They really don't want to be admitted to the hospital, and I think that's something that we could really learn from this activity, as well.
Oncology Data Advisor: Awesome. Well, thank you so much for your time today again, and this has been wonderful. I've enjoyed talking to you about this and thank you again for the activity and all the information.
Dr. Abbott: Thanks for having me.
Oncology Data Advisor: Yeah, and I hope to hear more about your research in the future.
Dr. Abbott: Great, thank you so much for everything.
If you would like access to learn more about preventing and managing chemotherapy-induced neutropenia, Dr. Abbott's free CME/NCPD activity is available here until April 24, 2023.
About Dr. Abbott
Maura Abbott, NP, MSN, PhD, is an Assistant Dean for the Clinical Affairs Department, Associate Professor of Nursing, and the Oncologist Health Specialty Program Director at the Columbia University School of Nursing. Dr. Abbott expresses the importance of understanding the patient's perspective and empathizing with them to understand and help them reach a positive outcome in their treatment. She has dedicated much of her time advocating for healthy nurse-patient relations.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.