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. IMPLICATIONS FOR PRACTICE: The results of this project support incorporating the discussed risk assessment model into routine nursing assessments to prevent neutropenic complications.
Chang, L-L; Schneider, SM; Chiang, S-C; Horng, C-F
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