Improving the relative dose intensity of systemic chemotherapy in a community-based outpatient cancer center.
OBJECTIVE
This three-phase study was performed to improve the mean relative dose intensity (RDI) of chemotherapy administered to patients in a community-based outpatient cancer center.


METHODS
Medical records were reviewed for patients who began receiving systemic chemotherapy for lymphoma or cancer of the breast, lung, endometrium, ovary, or colon. During phase 1, records were reviewed and the mean RDI was determined through collection of demographic, diagnostic, chemotherapy, and laboratory data. Phase 2 involved implementation of quality improvement initiatives to improve the RDI: development of a febrile neutropenia risk assessment tool, revision of our dose cancellation policy, and interdisciplinary education. Finally, after implementation of these initiatives, the mean RDI was prospectively determined in phase 3, similar to phase 1.


RESULTS
The mean RDI was determined to be 83% during phase 1 compared with 91% during phase 3 (P=.0087). For adjuvant chemotherapy, the mean RDI was 85% and 95% for phases 1 and 3, respectively (P=.0035). Likewise, for metastatic disease, the mean RDI was 76% and 82% for phases 1 and 3, respectively (P=.3935). The proportion of regimens that met or exceeded the recommended minimum goal RDI of 85% was 54% for phase 1 and 80% for phase 3. Granulocyte colony-stimulating factor use increased from 69% preintervention to 81% postintervention.


CONCLUSIONS
The mean overall RDI improved above the threshold goal of 85%, with the RDI for adjuvant chemotherapy reaching 95%, after implementation of three quality-improvement initiatives. With continued education and following policies already in place, further improvements in RDI could be demonstrated.
Sparrow Health System; Sparrow Regional Cancer Center, Lansing; and Ferris State University, Big Rapids, MI.
Kari L
KL
Vavra
Claire E
CE
Saadeh
Alisha L
AL
Rosen
Christine E
CE
Uptigrove
Gordan
G
Srkalovic
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002173:Cancer Care Facilities / Q000592:standards; D017024:Chemotherapy, Adjuvant / Q000592:standards; D003151:Community Health Centers / Q000592:standards; D004334:Drug Administration Schedule; D004358:Drug Therapy / Q000592:standards*; D017723:Drug Utilization Review; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D010045:Outpatients; D010349:Patient Compliance; D010818:Practice Patterns, Physicians'
D000970:Antineoplastic Agents; D016179:Granulocyte Colony-Stimulating Factor