Protocols for managing chemotherapy-induced neutropenia in clinical oncology practices.

Chemotherapy-induced neutropenia is managed in different ways in clinical practice. Chemotherapy dose reductions and delays are used more often than proactive, first-cycle use of colony-stimulating factors, but such dose modifications can result in suboptimal treatment outcomes. This article reviews how 3 oncology practices have used practice pattern studies to assess and improve their quality of care, particularly in the management of neutropenia. These practices analyzed their records for the occurrence of neutropenia and for delays or reductions in chemotherapy doses. Once baseline measurements of quality of care were established, the practices developed guidelines to optimize their management of neutropenia. The practice patterns were assessed again after the guidelines had been implemented, to determine the effect of these guidelines on clinical outcomes. All 3 practices had fewer delays and reductions of chemotherapy doses after the guidelines were used. These differences were both clinically and statistically significant. Clinical experience shows that nurses are well positioned to assess which patients may be at the greatest risk for neutropenia and its complications and therefore should be treated with colony-stimulating factors. Practice guidelines for the use of colony-stimulating factors are being developed, but broader acceptance of these guidelines is needed to support nurses' recommendations.