Aims: Although often required to reduce serious treatment related adverse events, evidence for dose modification of antineoplastic therapy is limited and usually based on clinical trial protocols, which are not always generalisable to community patients. eviQ is an online resource providing cancer treatment protocols with guidelines for dose modification formulated by expert opinion and evidence-based review. These guidelines originally recommended a threshold for treatment delay for neutrophil counts of less than 1.5 x 109 and platelet counts of less than 100 x 109. As attitudes to dose modification have changed with time, we sought to evaluate how rigidly Australian medical oncologists adhere to eviQ recommended haematological dose modifications.
Methods: An eviQ online survey regarding haematological dose modifications was distributed to over 400 Medical Oncology Group of Australia members and eviQ medical oncology reference committee members via email. Responses were collated on 18 December 2017.
Results: There were 153 respondents. 67% indicated that they did not follow the eviQ haematological dose modification guidelines. At a neutrophil count of less than 1.5 x 109 only 2% delayed curative intent treatment compared with 36% for palliative treatment, whereas most delayed treatment at a neutrophil count of less than 1.0 x 109 (88% curative and 97% palliative, respectively). 70% of clinicians delayed palliative treatment at a platelet count of less than 100 x 109, compared to 34% with curative treatment. No respondents indicated the original haematological cut off levels were too aggressive.
Conclusions: The majority of responding medical oncologists indicated that they did not follow the eviQ haematological dose modification guidelines, which they viewed as too conservative, especially in the curative setting. The survey results prompted eviQ to comprehensively review and ultimately alter dose modification recommendations for haematological toxicity.