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Managing Hematologic Toxicities: Novel Therapies

Nirenberg, Anita RN, MS, CNP, AOCN


Myelosuppression associated with cancer chemotherapy may lead to neutropenia, anemia, or both, resulting in an increased risk for infection, fatigue, diminished quality of life, and reduced survival. In addition, neutropenia specifically has been shown to result in dose reductions, treatment delays, or both in subsequent chemotherapy cycles. Hematopoietic growth factors have been used effectively as supportive therapy to reduce chemotherapy-associated neutropenia and anemia. New preparations have the potential to improve treatment outcome dramatically. Results from recently reported studies indicate that patients at risk for neutropenia can be safely and effectively treated with pegfilgrastim once per chemotherapy cycle, and that those with anemia can be managed with weekly or biweekly darbepoetin alfa therapy. These new treatments have the potential to reduce the morbidity and mortality associated with opportunistic infections, decrease the requirement for potentially dangerous blood transfusions, and improve the quality of life for patients undergoing cancer chemotherapy. The longer dosing intervals offered by these new preparations may decrease healthcare expenses and enhance patient adherence.

A primary complication of cancer treatment is chemotherapy-mediated myelosuppression, which often limits the usefulness of chemotherapy. 1 This complication may lead to neutropenia, thrombocytopenia, and/or anemia. 2 These adverse effects increase the risk for infection, bleeding, fatigue, diminished quality of life, and reduced survival. 2–4 The occurrence of myelosuppression also may lead to dose reductions, treatment delays, or both in subsequent chemotherapy cycles. 5,6 Thus, effective prevention and management of chemotherapy-associated myelosuppression is particularly important for reducing the risk of potentially fatal effects of such treatment, increasing tolerability, and permitting potentially curative therapy to be delivered at planned doses and intervals. The aim of this review is to discuss new approaches for hematologic support with hematopoietic growth factors among patients undergoing cancer chemotherapy and their implications for nursing.

From the Columbia University School of Nursing, New York, NY.

Corresponding author: Anita Nirenberg, RN, MS, CNP, AOCN, Columbia University School of Nursing, 617 W 168th St, New York, NY 10032.

Accepted for publication May 21, 2003.

© 2003 Lippincott Williams & Wilkins, Inc.