A cancer diagnosis is a significant, life-changing event for the entire family unit. Their sense of normalcy is suddenly interrupted by frequent doctor visits, painful and invasive procedures, and hospitalizations. All of these things can make the time surrounding a cancer diagnosis become a traumatic event for patients and their families.10

Health care providers have a responsibility to help patients and families minimize the suffering endured during treatment. Fewer injections throughout their treatment can relieve some of the trauma experienced by a child with cancer. Injections can be terrifying for any child regardless of health status, but even more so when the child has to receive them daily. The child’s anxiety and stress may also resonate onto the parent or caregiver who has to administer the injections. These emotions can lead to inconsistent adherence to the treatment schedule, thereby increasing the risks of medical complications. The number of injections a child must receive is reduced to one per chemotherapy cycle with pegfilgrastim, as opposed to one per day with filgrastim.2 For example, the recommended treatment for Ewing sarcoma, based on Children’s Oncology Group protocol, consists of 14 courses of chemotherapy.6 Use of filgrastim as the G-CSF agent with this treatment plan translates into approximately 140 subcutaneous injections, whereas pegfilgrastim would requires 14 subcutaneous injections. A single injection per cycle is a significant advantage for pediatric oncology patients and minimizes the treatment-related pain a child has to endure.11 This may also alleviate some of the caregiver’s stress, increasing adherence to treatment.

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Children maintain a sense of stability when they have a routine in their life. Cancer disrupts that routine in many different ways and can lead to patients and families feeling a lack of control.10 This feeling is magnified when the child has to be hospitalized due to febrile neutropenia. The child is unable to attend school with friends, practice sports, or even play with siblings. The parent or caregiver often must take a leave of absence from work in order to be with their sick child, leading to increased financial worries. The risk of neutropenia is significantly reduced with G-CSFs, specifically pegfilgrastim,6 which could mean fewer hospitalizations and less disruption for a child and family who are already facing so much. The child would be able to maintain a sense of normalcy by attending school and interacting with friends, and the parents would retain control of working and being available for all the family members.

Neutropenia negatively affects quality of life by predisposing patients to hospital admissions and isolation.2 Fever and neutropenia require hospitalization for IV antibiotics and place both an emotional and financial toll on families due to loss of work and disruption of family life.4 Granulocyte colony-stimulating factors have been proven to decrease the incidence of fever and neutropenia in children with cancer.8 Studies comparing filgrastim with pegfilgrastim in pediatric oncology patients demonstrate that pegfilgrastim can be used safely and efficacy is similar with both drugs.8 The need for fewer injections with pegfilgrastim can improve quality of life for pediatric oncology patients and their families. ONA 

Karen MacDonald is a Pediatric Hematology Oncology Nurse Clinician at William Beaumont Hospital in Royal Oak, Michigan. Hayley Bee and Darby Tozer are nurses at Detroit Medical Center (DMC) Children’s Hospital of Michigan. Jennifer Train is a staff nurse at DMC Urology Clinic.


1. Baggot C, Fochtman D, Foley G, Kelly KP. Nursing Care of Children and Adolescents with Cancer and Blood Disorders. 4th ed. Glenview, IL: Association of Pediatric Hematology/Oncology Nurses; 2011.

2. Milano-Bausset E, Gaudart J, Rome A, et al. Retrospective comparison of neutropenia in children with Ewing sarcoma treated with chemotherapy and granulocyte colony-stimulating (G-CSF) or pegylated G-CSF. Clin Ther. 2009;31:2388-2395. doi:10.1016/j.clinthera.2009.11.013.

3. van de Wetering MD, Schouten-van Meeteren NY. Supportive care for children with cancer. Semin Oncol. 2011;38(3):374-379. doi: 0.1053/j.seminocol.2011.03.006.

4. Andre N, El Kababri M, Bertrand P, et al. Safety and efficacy of pegfilgrastim in children with cancer receiving myelosuppressive chemotherapy. Anticancer Drugs. 2007;18(3):277-281.

5. Yaffe SJ, Aranda JV. Neonatal and Pediatric Pharmacology:Therapeutic Principles in Practice. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.

6. Wendelin G, Lackner H, Schwinger W, et al. Once-per-cycle pegfilgrastim versus daily filgrastim in pediatric patients with Ewing sarcoma. J Pediatr Hematol Oncol. 2005;27(8):449-451.

7. te Poele EM, Kamps WA, Tamminga RY, et al. Pegfilgrastim in pediatric cancer patients. J Pediatr Hematol Oncol. 2005;27(11):627-629.

8. Spunt SL, Irving H, Frost J, et al. Phase II, randomized, open-label study of pegfilgrastim supported VDC/IE chemotherapy in pediatric sarcoma patients. J Clin Oncol. 2010;28(8):1329-1336. doi:10.1200/JCO.2009.24.8872.

9. Cesaro S, Zanazzo AG, Frenos S, et al. A phase II study on the safety and efficacy of a single dose of pegfilgrastim for mobilization and transplantation of autologous hematopoietic stem cells in pediatric oncohematology patients. Transfusion. 2011;51(11):2480-2487. doi:10.1111/j.1537-2995.2011.03157.x.

10. National Cancer Institute. Pediatric Supportive Care. Accessed May 15, 2012.

11. Fox E, Widemann BC, Hawkins DS, et al. Randomized trial and pharmacokinetic study of pegfilgrastim vs. filgrastim after dose-intensive chemotherapy in young adults and children with sarcomas. Clin Cancer Res. 2009;15(23):7361-7367. doi:10.1158/10780432.CCR-09-0761.