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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

doi: 10.1097/NCC.0b013e3182642d98

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.

Author Affiliations: Center for Advancement of Nursing Education (Dr Chang) and Departments of Pharmacy (Dr Chiang) and Clinical Research (Mr Horng), Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan; and Duke University School of Nursing, Durham, North Carolina (Dr Schneider).

The authors have no funding or conflicts of interest to disclose.

Correspondence: Li-Lu Chang, DNP, RN, Center for Advancement of Nursing Education, Koo Foundation Sun Yat-Sen Cancer Center, 125 Lih-Der Rd, Taipei, Taiwan 11259 (

Accepted for publication June 9, 2012.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins