Implementing an evidence-based risk assessment tool to predict chemotherapy-induced neutropenia in women with breast cancer.
BACKGROUND
Several studies have documented the efficacy of prophylactic granulocyte colony-stimulating factor in reducing rates of infections and risk of febrile neutropenia. An appropriate risk assessment model is pivotal to identify high-risk patients who would require granulocyte colony-stimulating factor prophylaxis.


OBJECTIVE
The objectives of the study were to develop, implement, and evaluate a risk assessment model for neutropenic events in breast cancer patients who were receiving myelosuppressive chemotherapy.


METHODS
During the study period, neutropenia risk was assessed for breast cancer patients by using an innovative risk model before the first cycle of chemotherapy. A stepwise logistic regression model was performed to determine significant factors for the prediction.


RESULTS
A total of 119 patients were evaluated for neutropenia risk between August 2010 and December 2010. Twenty-nine percent (35/119) of the patients have experienced at least 1 neutropenic event during the initial 3 cycles of chemotherapy. Based on the logistic regression model, only the risk score was retained as the significant predictor; the probability of an individual patient developing neutropenic events increased 1.24 times by increasing 1 score number (odds ratio, 1.24; with 95% confidence interval, 1.063-1.457).


CONCLUSIONS
Based on the examination of different cutoff points, the performance of the risk model is best when the risk threshold is set at 6, which was found to have a sensitivity of 0.49 and a specificity of 0.69; the misclassification rate was 0.37, with a positive predictive value of 0.40 and a negative predictive value of 0.76.


CONCLUSIONS
The results of this project support incorporating the discussed risk assessment model into routine nursing assessments to prevent neutropenic complications.
Center for Advancement of Nursing Education, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan. chang@kfsyscc.org
Li-Lu
LL
Chang
Susan M
SM
Schneider
Shao-Chin
SC
Chiang
Cheng-Fang
CF
Horng
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000451:nursing*; D019317:Evidence-Based Medicine; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000175:diagnosis / Q000451:nursing* / Q000517:prevention & control; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity
D016179:Granulocyte Colony-Stimulating Factor