Skip Navigation LinksHome > May/June 2013 - Volume 36 - Issue 3 > Implementing an Evidence-Based Risk Assessment Tool to Predi...
Cancer Nursing:
doi: 10.1097/NCC.0b013e3182642d98
Articles

Implementing an Evidence-Based Risk Assessment Tool to Predict Chemotherapy-Induced Neutropenia in Women With Breast Cancer

Chang, Li-Lu DNP, RN; Schneider, Susan M. PhD, RN; Chiang, Shao-Chin PharmD; Horng, Cheng-Fang MS

Collapse Box

Abstract

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.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Login

Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.