OVERVIEW

Despite advances in the management of chemotherapy-induced myelosupression, neutropenia remains a major dose-limiting toxicity of systemic antineoplastic therapy and is associated with substantial morbidity, mortality, and healthcare costs. Development of fever in the setting of neutropenia (febrile neutropenia [FN]) represents a potentially fatal condition because it places oncology patients at a considerable risk of developing major bacterial and/or fungal infections. Most episodes of FN require prolonged hospitalization, often leading to increased hospital expenditure and significant risks of inpatient mortality. FN may also lead to dose reductions or treatment delays in subsequent chemotherapy cycles, which may have a considerable life-threatening impact on disease control in responsive and potentially curable malignancies. Because prophylactic use of granulocyte-colony stimulating factors (G-CSFs) has been shown in multiple studies to reduce the risk, severity, and duration of FN, primary prophylaxis may minimize delays and dose reductions in chemotherapy regimens and potentially reduce FN-associated hospitalizations. As a result, several oncology guidelines advocate prophylactic use of G-CSFs in at-risk patents, specifically those receiving chemotherapy regimens that are associated with a greater than 20% incidence of FN. The focus of current research is to better define length of hospital stay and cost associated with FN, develop standardized clinical tools for identifying risk factors for FN-associated mortality and hospitalizations, and explore cost effectiveness of G-CSF prophylaxis in various oncology settings.

GOAL

This educational activity will provide medical oncologists, oncology pharmacists, and oncology nurses with up-to-date information about the treatment and management of patients with chemotherapy-induced febrile neutropenia.

INTENDED AUDIENCE

This activity is designed for medical oncologists, oncology pharmacists, and oncology nurses working with patients with chemotherapy-induced febrile neutropenia. No prerequisites required.

LEARNING OBJECTIVES

Upon the conclusion of this activity, the participant should be able to:

• Describe the importance of assessing a patient's risk for chemotherapy-induced febrile neutropenia.
• Contrast the National Comprehensive Cancer Network and American Society of Clinical Oncology’s guidelines for colony stimulating factors.
• Explain the rationale for a proactive approach to risk assessment and prevention of febrile neutropenia.
• Describe a strategy for overcoming barriers to implementing practice-specific guidelines.
• Develop a method to track compliance to colony stimulating factor guidelines. 

The Johns Hopkins University School of Medicine, The Institute for Johns Hopkins Nursing, and The University of Tennessee College of Pharmacy take responsibility for the content, quality, and scientific integrity of this CE activity.

CME INFORMATION

Accreditation Statement — This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Johns Hopkins University School of Medicine, The Institute for Johns Hopkins Nursing, and The University of Tennessee College of Pharmacy. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education to provide continuing education for pharmacists.

Credit Designation Statement — The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This 0.75 contact hour educational activity is provided by The Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Contact hours will be awarded for this educational activity until June 4, 2012.

The University of Tennessee College of Pharmacy is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. Successful completion of this application-based educational activity will provide 0.75 contact hours of credit (0.75 CEUs). A statement of CPE credit will be available online immediately following successful completion of the activity. Successful completion includes taking the pre-test, viewing the podcast session, and completing the post-test and educational activity evaluation. ACPE Program #064-000-10-205-H01-P.

The estimated time to complete this activity: 45 minutes.

Release date: June 4, 2010. Expiration date: June 4, 2012.

Fee: There is no fee for this educational activity.

HOW TO RECEIVE CREDIT OR CONTACT HOURS
Participants may receive credit by completing pre-test, reviewing the activity, and completing the CE test and evaluation. A certificate of participation/statement of credit will be available online immediately following successful completion of the activity.

FACULTY
Full Disclosure Policy Affecting CME Activities
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation.

Policy on Faculty and Provider Disclosure
It is the policy of The Institute for Johns Hopkins Nursing to require our continuing nursing education faculty and planning committee members to disclose any financial relationships with companies providing program funding or manufacturers of any commercial products discussed in the educational activity.

Full Disclosure Policy Affecting CPE Activities
As an accredited provider by the Accreditation Council for Pharmacy Education, it is the policy of The University of Tennessee College of Pharmacy to require the disclosure of the existence of any relevant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation.

The Steering Committee and Participating faculty reported the following:

STEERING COMMITTEE
Katherine DeLorenzo, MD (Co-Course Director)
Assistant Professor in Oncology and Medicine
Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins University
Baltimore, Maryland
Dr DeLorenzo reports serving as the principal investigator on grants/research for Amgen Inc, Ariad, Genentech, Inc, and Novartis Pharmaceuticals Company.

Suzanne M. Cowperthwaite, MSN, RN (Co-Course Director)
Assistant Director of Nursing
Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins University
Baltimore, Maryland
Ms Cowperthwaite reports having no relationships with commercial interests related to this activity.

Susan Hudock, PharmD, BCOP (Co-Course Director)
Johns Hopkins Hospital
Oncology Investigational Pharmacy
Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins University
Baltimore, Maryland
Dr Hudock reports having no relationships with commercial interests related to this activity.

Indu Lew, PharmD
Saint Barnabas Health Care System
Corporate Vice President
Pharmacy Education and Research
South Plainfield, New Jersey
Dr Lew reports having no relationships with commercial interests related to this activity.

Saroj Vadhan-Raj, MD
Professor of Medicine
Internist, Department of Sarcoma Medical Oncology
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, Texas
Dr Vadhan-Raj reports receiving grants/research support from Amgen Inc, Bristol-Myers Squibb, Eisai Inc, EUSA, GlaxoSmithKline, Merck & Co, Inc, Nuvelo, Inc, and Sanofi-Aventis; serving as a consultant for S3Bio Inc; receiving honoraria from Amgen Inc, Cytogen Corporation, Johnson & Johnson, Merck & Co, Inc, and Sanofi-Aventis; and serving on the speakers’ bureau for Sanofi-Aventis.

PARTICIPATING FACULTY
Niesha Griffith, MS, RPh, FASHP
Director of Pharmacy
The James Cancer Hospital at The Ohio State University
Columbus, Ohio
Ms Griffith reports serving as a consultant and on the speakers’ bureau for and receiving honoraria from Amgen Inc. Her department also received a grant from Amgen Inc.

Note: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution which receives the grant, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

OFF-LABEL PRODUCT DISCUSSION
No faculty member has indicated that their presentation will include information on off-label products.

NON-ENDORSEMENT OF PRODUCTS
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

Internet CME Policy
The Office of Continuing Medical Education (CME) at the Johns Hopkins University School of Medicine is committed to protect the privacy of its members and customers.  Johns Hopkins University SOM CME maintains its Internet site as an information resource and service for physicians, other health professionals, and the public. Continuing Medical Education at the Johns Hopkins University School of Medicine will keep your personal and credit information confidential when you participate in a CME Internet based activity. Your information will never be given to anyone outside of the Johns Hopkins University School of Medicine’s CME activity. CME collects only the information necessary to provide you with the services that you request. 

The Institute for Johns Hopkins Nursing Mission Statement
The mission of The Institute for Johns Hopkins Nursing is to share the innovations of Johns Hopkins Nursing in practice, education, and research—locally, nationally, and globally.

Our goal in continuing nursing education is to bring you activities that reflect the expertise and creativity of Johns Hopkins Nursing.  Our service values are quality, integrity, flexibility, and personal attentiveness.  We appreciate your thoughts and welcome your concerns. Please feel free to e-mail us: IJHN@son.jhmi.edu.

Grievance Policy
A participant, sponsor, faculty member, or other individual wanting to file a grievance with respect to any aspect of an activity sponsored or co-sponsored by The University of Tennessee College of Pharmacy may contact the Associate Dean for Continuing Education in writing. The grievance will be reviewed and a response will be returned within 45 days of receiving the written statement. If not satisfied, an appeal to the Dean of the College of Pharmacy can be made for a second level of review.

Hardware & Software Requirements
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

ACTIVITY
Instructions
The following podcast activity consists of 3 sections: an unaccredited pre-test, 2 interview-based podcast, and a CE post-test. All 3 sections must be completed to receive CE credit.

Pre-Test

Evidence Based Management of Chemotherapy-Induced Febrile Neutropenia
Interview with Katherine DeLorenzo, MD, moderated by Suzanne M. Cowperthwaite, MSN, RN

Improving Outcomes for Patients with Chemotherapy-Induced Febrile Neutropenia: Success Stories from a University Based Practice
Interview with Niesha Griffith, MS, RPh, FASHP, moderated by Indu Lew, PharmD

Post-Test