Protocols for managing chemotherapy-induced neutropenia in clinical oncology practices

Evidence Generation of Standard Nursing Protocol on Chemotherapy-Induced Neutropenia Among Oncology Nurses

Background Chemotherapy uses anti-neoplastic agents, the drugs used to treat malignancies. Neutropenia is associated with cytotoxic therapy. Anti-neoplastic agents are poisonous to the cells, affecting the synthesis of folic acid and damaging the DNA, RNA, and protein that damage the bone marrow. Destruction of bone marrow decreases absolute neutrophil count in the blood. To assess the baseline data and practice of oncology nurses, develop and implement the evidence-based standard nursing protocol, assess the satisfaction level of the patients for the utility of the standard nursing protocol, find out the correlation between knowledge and practice and to associate the knowledge and practice score with selected demographic variables. Material And Method In the study quasi-experimental design was utilized. The study was conducted at Siddharth Gupta Memorial Cancer Hospital, Sawangi (Meghe), Wardha city, between June to Aug 2022 Result The result of the study shows the mean value per existing knowledge is 7.59 and practices is 37.95, post knowledge is 14.23, and post practices is 71.15. The standard deviation values of per exiting knowledge are 2.67 and, practice 3.09 and, post knowledge is 2.32, post practices are 1.32. The calculated t-value of knowledge is 46.57and the p-value is 0001. The calculated t-value of practice is 12.03, and the p-value is 0.0001. Conclusion The present research concluded that the knowledge and skills of oncology nurses are enhanced after implementing the standard nursing protocol.

Bundle for the prevention and management of complications of neutropenia in cancer patients

OBJECTIVES

to construct and assess bundle content for the prevention and management of complications in neutropenia in cancer patients.

METHODS

a methodological study developed in four stages: scoping review; bundle construction; material assessment by experts (developed according to Pasquali's psychometry); pilot test in a High Complexity Assistance Unit in Oncology. For content assessment, the Delphi technique was applied in two rounds and those items with Content Validation Coefficient (CVC)> 0.78 and agreement> 80.0% were considered valid. Data were analyzed using descriptive and inferential statistics.

RESULTS

all bundle requirements reached agreement between judges above 80.0%, in addition to statistically significant levels of assessment. At the end of the Delphi technique, bundle was significantly valid with CVC = 0.92 and CVC = 0.93, respectively.

CONCLUSIONS

bundle content proved to be valid and highly credible.

Dose intensity in early-stage breast cancer: a community practice experience

Although nodal status, grade, size, and receptor status play roles in determining breast cancer prognosis, there is increasing evidence that maintaining dose intensity of adjuvant chemotherapy increases disease-free survival rate.

Managing neutropenia in older patients with cancer receiving chemotherapy in a community setting

Older patients with cancer who may be more susceptible than younger patients to the myelosuppressive effects of chemotherapy undergo dose delays and reductions that can compromise treatment outcomes. Incidence of neutropenic complications and suboptimal chemotherapy delivery can be reduced with prophylactic colony-stimulating factors; however, their use in older patients with cancer has not been well studied. A randomized, multicenter, community-based trial was designed to compare prophylactic pegfilgrastim use (all cycles of chemotherapy) versus its more common reactive use (at clinicians' discretion) in patients aged 65 years or older with various cancers. Pegfilgrastim use in all cycles reduced the incidence of febrile neutropenia by about 60% and hospitalizations caused by neutropenia and febrile neutropenia by about 50% versus reactive pegfilgrastim use in later cycles. The study showed that older patients with cancer can be treated safely with optimal doses of chemotherapy with appropriate supportive care. Nurses, key collaborators in providing supportive care, can take an active role in identifying older patients who may benefit from pegfilgrastim in all cycles of chemotherapy.

Using a computer-based risk assessment tool to identify risk for chemotherapy-induced febrile neutropenia

This article evaluates the feasibility of developing and implementing a computer-based risk assessment tool (CBRAT) for febrile neutropenia and determines whether it could improve documentation of risk assessment in patients starting myelosuppressive chemotherapy regimens. The CBRAT was designed using a template creator in a commercial electronic medical records system. The effectiveness of the CBRAT was evaluated by comparing medical records data of patients with one or more risk factor for febrile neutropenia who were given prophylactic granulocyte-colony-stimulating factor before and after implementation. CBRAT usage significantly increased the likelihood of documented febrile neutropenia risk assessment from 13% before implementation to 100% after implementation (p < 0.001). No significant changes occurred in febrile neutropenia incidence rates, dose reductions, or dose delays. In addition, healthcare providers quickly learned how to operate the CBRAT and used it routinely, significantly improving the number of patients with documented febrile neutropenia risk assessment. Implementation of a computer-based tool can help nurses follow evidence-based guidelines that recommend routine febrile neutropenia risk assessment for patients initiating myelosuppressive chemotherapy.

Baseline evaluation of the AIM Higher Initiative: establishing the mark from which to measure

PURPOSE/OBJECTIVES

To collect baseline measurements before the implementation of interventions associated with the AIM (Assessment Information Management) Higher Initiative--a quality improvement program intended to improve symptom assessment, management, and information distribution for five chemotherapy-related symptom groups: anemia, neutropenia, diarrhea and constipation, nausea and vomiting, and depression and anxiety.

DESIGN

Subject telephone interviews and chart reviews.

SETTING

15 community oncology clinics in the United States.

SAMPLE

376 adult patients with cancer who visited a healthcare provider before the start of a chemotherapy cycle; patients were enrolled in the study after the initiation of chemotherapy, with at least one chemotherapy cycle remaining.

METHODS

Subject interviews and chart reviews to determine the frequency, assessment, and management of and information about target symptoms.

MAIN RESEARCH VARIABLES

The frequency of target chemotherapy-related symptoms and occurrence of symptom-specific assessment, information provided, and management.

FINDINGS

The five target symptoms had occurred in a considerable proportion of patients with cancer receiving chemotherapy during their most recent chemotherapy cycles. At a substantial number of clinic visits, no documentation of cancer-related symptom assessment, information distribution, or management occurred.

CONCLUSIONS

Chemotherapy-related symptoms occur frequently but often are not assessed, managed, or handled with appropriate patient information.

IMPLICATIONS FOR NURSING

Findings in the baseline evaluation illustrate the need to improve supportive care--a key responsibility of oncology nurses.

Nurses' guide to understanding and implementing the National Comprehensive Cancer Network guidelines for myeloid growth factors

PURPOSE/OBJECTIVES

To review and determine the applicability of the 2006 National Comprehensive Cancer Network (NCCN) clinical practice guidelines for the use of myeloid growth factors in adult patients treated with chemotherapy for solid tumors and nonmyeloid malignancies.

DATA SOURCES

Published guidelines, original research, review articles, and conference presentations.

DATA SYNTHESIS

Chemotherapy-induced neutropenia is a common adverse effect of myelosuppressive chemotherapy that may lead to life-threatening infections, prolonged hospitalization, increased IV antibiotic use, and dose reductions or delays that affect patients' quality of life and clinical outcomes.

CONCLUSIONS

Before treatment begins, nurses should determine which patients are at greater risk for chemotherapy-induced neutropenia and implement an appropriate plan of care.

IMPLICATIONS FOR NURSING

Nurses are in an ideal position to implement a risk assessment tool and play an integral role in directing the quality of patient care. Implementing the NCCN guidelines is one way to facilitate standardization of care.

A Review of Anemia Management in the Oncology Setting: A Focus on Implementing Standing Orders

Standing orders serve an important role in various healthcare settings by empowering nurses to implement certain procedures and activities on behalf of physicians, enabling more immediate interventions, and ultimately improving patient care. Standing orders are based on established clinical practice guidelines and are well suited for supportive interventions. Several evidence-based clinical practice guidelines are available for the treatment of anemia in patients with cancer. The guidelines can serve as a basis for the development of standing orders for the management of treatment-related anemia in patients with cancer, which will enable the delivery of consistently high-quality care to patients. A major advantage to the implementation of standing orders is that patients with suboptimal hemoglobin levels can be treated by oncology nurses in a timely manner and receive high-quality care that is consistent with available clinical evidence.

Development and implementation of a risk assessment tool for chemotherapy-induced neutropenia

PURPOSE/OBJECTIVES

To evaluate a tool developed and implemented to help practitioners assess the risk of chemotherapy-induced neutropenia (CIN) and its complications in patients with nonleukemia cancer types.

DESIGN

Retrospective survey of chart records.

SETTING

Community-based oncology practice.

SAMPLE

The medical records of 85 adult patients treated with new courses of chemotherapy, regardless of the cancer type or stage; 50 charts belonged to patients treated before the implementation of the tool and 35 to patients evaluated with the tool.

METHODS

A risk assessment tool for CIN that was developed using risk factors from published studies and national guidelines was implemented. Patients who were found to be at increased risk for CIN were given colony-stimulating factor (CSF) support starting with the first chemotherapy cycle. The effectiveness of the tool was evaluated by comparing clinical outcomes before and after the implementation of the risk assessment tool.

MAIN RESEARCH VARIABLES

Febrile neutropenia, IV antibiotic use, hospitalization for neutropenia, and chemotherapy dose reductions and delays.

FINDINGS

Chemotherapy dose delays, febrile neutropenia, treatment with IV antibiotics, and hospitalization for neutropenia occurred less frequently in patients assessed with the tool and managed with the algorithm for CSF use than in those who were not assessed.

CONCLUSIONS

The Risk Assessment for Neutropenic Complications Tool is effective in helping practitioners determine which patients are at high risk for CIN and its complications

IMPLICATIONS FOR NURSING

By using the tool to identify patients treated with chemotherapy who need growth factor support, nurses can help to reduce the incidence of neutropenia and its complications.