Dose-dense adjuvant chemotherapy for breast cancer.

Dose intensity, the amount of drug delivered per unit of time, is an important predictor of outcome in adjuvant chemotherapy for breast cancer. It can be increased by using higher doses of chemotherapy (dose escalation) or by shortening the interval between cycles (dose density). Dose-escalation strategies (adjuvant high-dose chemotherapy with bone marrow or peripheral blood progenitor cell support) have shown no benefit in patients with breast cancer. In contrast, dose-dense regimens (given every 2 weeks) are associated with greater disease-free and overall survival than are conventional, 3-week regimens. Toxicity with dose-dense regimens should be managed as it is with conventional regimens, but the timing of interventions may differ, and supportive care, such as providing granulocyte colony-stimulating factor support in all cycles of chemotherapy to reduce the incidence and duration of neutropenia, can help facilitate the safe delivery of dose-dense regimens. Oncology nurses should be involved in developing and implementing educational plans that help patients become aware of the potential advantages of dose-dense therapy and the potentially greater risk of toxicity. With conventional and dose-dense regimens alike, maintaining dose intensity through the optimal management of adverse events can help ensure better outcomes.