Abernethy Amy P, Barbour Sally Y, Uronis Hope, Zafar S Yousuf, Coan April, Rowe Krista, Pupa Mary Ruth, Wheeler Jane L, Herndon James E
Department of Medicine, Division of Medical Oncology, Duke University Medical Center (DUMC), Box 3436, Durham, NC 27710, USA.
Support Care Cancer. 2009 Jun;17(6):735-44. doi: 10.1007/s00520-008-0562-6. Epub 2008 Dec 19.
Management of the risk of potential chemotherapy-induced neutropenic complications such as febrile neutropenia (FN) and severe neutropenia (SN) is a quality of care priority. How frequently does care at our institution conform to established guidelines?
This retrospective chart review study included a random sample of 305 cancer patients receiving care at a single US academic medical center. Abstracted data included demographics, risk factors, and outcome variables (e.g., development of FN/SN, administration of myeloid growth factors). To evaluate quality of care, we assessed conformance between actual practice and established clinical practice guidelines for the use of myeloid growth factors from the National Comprehensive Cancer Network (NCCN).
Of the 305 cases reviewed, 8% were classified as low risk (<10%), 48% as intermediate risk (10-20%), and 44% as high risk (>20%), using the risk classifications in the NCCN guidelines modified to accommodate illness and other risk factors. Thirty-four percent received prophylactic administration of myeloid growth factors. Half of the cases had adequate documentation of mid-cycle absolute neutrophil count to determine whether FN/SN developed. Among these cases with adequate documentation, 21% developed FN/SN. Use of growth factors did not conform to established quality guidelines. Overall, 77 of 133 (58%) high-risk cases received myeloid growth factors, whereas six of 25 (24%) low-risk cases received myeloid growth factors.
Routine clinical practice in this academic oncology setting was poorly aligned with established guidelines; there is substantial opportunity to standardize clinical strategies and increase conformance with evidence-based guidelines.
管理潜在化疗诱导的中性粒细胞减少并发症（如发热性中性粒细胞减少症（FN）和严重中性粒细胞减少症（SN））的风险是护理质量的优先事项。我们机构的护理符合既定指南的频率如何？
这项回顾性图表审查研究纳入了在美国一家学术医疗中心接受治疗的305名癌症患者的随机样本。提取的数据包括人口统计学、风险因素和结果变量（例如，FN/SN的发生、髓系生长因子的使用）。为了评估护理质量，我们评估了实际做法与美国国立综合癌症网络（NCCN）关于髓系生长因子使用的既定临床实践指南之间的一致性。
在审查的305例病例中，根据NCCN指南中为适应疾病和其他风险因素而修改的风险分类，8%被归类为低风险（<10%），48%为中度风险（10 - 20%），44%为高风险（>20%）。34%接受了髓系生长因子的预防性使用。一半的病例有足够的周期中绝对中性粒细胞计数记录，以确定是否发生了FN/SN。在这些有足够记录的病例中，21%发生了FN/SN。生长因子的使用不符合既定的质量指南。总体而言，133例高风险病例中有77例（58%）接受了髓系生长因子，而25例低风险病例中有6例（24%）接受了髓系生长因子。
在这个学术肿瘤学环境中的常规临床实践与既定指南的一致性较差；有很大机会规范临床策略并提高与循证指南的一致性。
