[A single-center, randomized controlled trial of PEG-rhG-CSF and common rhG-CSF to promote neutrophil recovery after induction chemotherapy in newly diagnosed acute myeloid leukemia]

Clinical efficacy and safety of comprehensive nursing intervention in acute leukemia patients with myelosuppression after chemotherapy

OBJECTIVE

To investigate the clinical efficacy and safety of comprehensive nursing intervention in acute leukemia patients with myelosuppression after chemotherapy.

METHODS

Eighty acute leukemia patients with myelosuppression after chemotherapy admitted to our hospital from April 2018 to December 2021 were selected and divided, according to the nursing mode, as the conventional group (n=40) with routine nursing mode and the comprehensive group (n=40) with the comprehensive nursing mode. Patients' anxiety (Self-Rating Anxiety Scale, SAS) scores, depression (Self-Rating Depression Scale, SDS) scores, occurrence of complications, nursing satisfaction, nursing experience, complaint rate, and Visual Analogue Scale (VAS) score were compared between the two groups so as to analyze the efficacy and safety of comprehensive nursing intervention. The improvement of quality of life in the two groups was observed and analyzed using the short form of quality of life measurement (WHOQOL-BREF). Logistic regression analysis was performed to analyze the risk factors for nosocomial infection in patients with comprehensive nursing intervention.

RESULTS

No statistically significant differences in SAS and SDS scores between the two groups were found prior nursing (P>0.05), while after nursing, scores in the two groups both decreased, with those in the comprehensive group significantly lower than in the conventional group (P<0.05). The incidence of complications after nursing in the comprehensive group was significantly lower than that in the conventional group, and the difference was statistically significant (P<0.05). Nursing satisfaction of patients in the comprehensive group were significantly higher than that in the conventional group (P<0.05). After nursing, the nursing experience of the comprehensive group was significantly better than that of the conventional group (P<0.05); the complaint rate of the comprehensive group was significantly lower than that of the conventional group (P<0.05); before nursing, there was no significant difference in the VAS scores between the two groups of patients (P>0.05); after nursing, the VAS score of the comprehensive group was significantly lower than that of the conventional group (P<0.05). Before nursing, there was no significant difference in WHOQOL-BREF scores between the two groups (P>0.05); after nursing, the comprehensive group was higher than the conventional group. Among the 40 patients in the comprehensive nursing group, 15 patients developed infection. The number of neutrophils, age above 40, white blood cell count, hemoglobin content, high-intensity chemotherapy and glucocorticoid therapy were independent risk factors for nosocomial infection in patients with comprehensive nursing intervention (P<0.05).

CONCLUSION

Comprehensive nursing intervention for patients with myelosuppression after chemotherapy for acute leukemia can effectively improve the patient's nursing experience, reduce the patient's complaint rate, alleviate the patient's physical pain, relieve the patient's anxiety, depression and other negative emotions, and reduce the patient's complications, suggesting that comprehensive nursing intervention exerts better clinical efficacy and has high safety, which merits promotion clinically.

Cost-Effectiveness Analysis of PEG-rhG-CSF as Primary Prophylaxis to Chemotherapy-Induced Neutropenia in Women With Breast Cancer in China: Results Based on Real-World Data

Background: Pegylated recombinant human granulocyte colony-stimulating factors (PEG-rhG-CSFs) are more commonly and widely used than recombinant human granulocyte colony-stimulating factors (rhG-CSFs) in preventing chemotherapy-induced neutropenia in patients with stage II-IV breast cancer. To reduce the financial burden on these patients, the corresponding medical insurance directory needs to be revised.

Objectives: To evaluate the cost-effectiveness of PEG-rhG-CSF versus rhG-CSF in patients with stage II-IV breast cancer in central China.

Methods: Two Markov models, a chemotherapy model and a post-chemotherapy model, were developed to study the effects and costs, with a time horizon of 12 weeks and 35 years, respectively. Cost and probability input data were primarily obtained from a retrospective real-world study conducted in five tertiary hospitals. Propensity score matching was adopted to overcome retrospective bias. Other parameters were extracted from literature as well as advice from clinical experts. Univariate and probabilistic sensitivity analyses were conducted.

Results: In the first chemotherapy model, PEG-rhG-CSF was associated with fewer episodes of febrile neutropenia (FN) (N = 19 per 1000 patients treated), infections (N = 24 per 1000 patients treated) and deaths (N = 2 per 1000 patients treated), but higher costs (¥36 more per patient treated). The post-chemotherapy model indicated that PEG-rhG-CSF led to higher gains in quality-adjusted life years (QALYs) (11.695 versus 11.516) in comparison to rhG-CSF. Sensitivity analysis showed that the cost of PEG-rhG-CSF had the greatest impact on the incremental costs, and incremental QALYs were very sensitive to the risk of RDI <85%. The probability of PEG-rhG-CSF being cost-effective compared to rhG-CSF was 66% at the willingness to pay (WTP) thresholds of ¥72,371 per QALY gained.

Conclusion: According to this economic evaluation based on real-world data, PEG-rhG-CSF may be considered as a more cost-effective strategy relative to rhG-CSF for stage II-IV breast cancer patients in central China. However, to reflect a national perspective, further evidence is needed using data from larger-scale studies.