The prevalence of neutropenia in chemotherapy cancer patients at a provincial hospital, Thailand

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
Y Suwannapong ◽  
D Chinwong ◽  
N Niamhun
Keyword(s):  
Febrile Neutropenia ◽  
Patient Care ◽  
Cancer Patients ◽  
Patient Care Team ◽  
Care Team ◽  
Cost Of Treatment ◽  
Cross Sectional ◽  
Practical Action ◽  
Provincial Hospital ◽  
Chemotherapy Patients

Abstract Introduction Cancer patients with neutropenia (<1500 cell/mm3 absolute neutrophil count [ANC]) are at high risk of febrile neutropenia and serious complications which can cause the delay treatment, reduction of chemotherapy dose, leading to morbidity and mortality. We lack of information of the prevalence of neutropenia in Thailand and its' consequences. Thus, this cross-sectional study aimed to investigate the prevalence of neutropenia at a provincial hospital in northern Thailand. Methods We retrospectively reviewed electronic medical records of cancer patients with solid tumor and receiving chemotherapy from September 2018 to October 2019. Results A total of 248 cancer patients (79 men, 169 women, mean age of 58.36±12.03) were included. The top 3 cancers were colon, breast and lung cancer (50.53%, 34.33%, 6.88%). They received chemotherapy 1,803 cycles of treatment. The top 3 regimens of treatment were FOLFOX (oxaliplatin/ fluorouracil/ leucovorin), AC (doxorubicin/ cyclophosphamide) and paclitaxel (42.65%, 17.75%, 9.67%). The prevalence of neutropenia (<1500 cell/mm3) was 264 episodes: 64 episodes of ANC 1,000-1,500 cell/mm3 (3.55%); 172 episodes of ANC 500-1,000 cell/mm3 (9.54%); and 28 episodes of ANC <500 cell/mm3 (1.55%). Most of them were postponed the treatment, but 16 episodes were still received chemotherapy. The dose of chemotherapy in 78 episodes were decreased and 16 episodes were related to the treatment of febrile neutropenia. The treatment of febrile neutropenia chemotherapy patients was 8 + 3 days with an average of US$ 400 per person, per cost of treatment. Conclusions We found that the effects of neutropenia in chemotherapy patients were delayed treatment, dose reduction and a major risk factor of febrile neutropenia. This decreased the efficiency of chemotherapy in patients with cancer. The result should be informed and encouraged our patient care team to develop practical action for prevention and management of serious neutropenic events. Key messages The result should be informed and encouraged our patient care team to develop practical action for prevention and management of serious neutropenic events. If we can manage cancer patients with neutropenia, the cost of treatment for serious febrile neutropenia and other complications will be reduced.

scholarly journals 4CPS-365 Integration of the hospital pharmacist into a multidisciplinary complex chronic patient care team

2021 ◽  
Author(s):  
N Galán Ramos ◽  
A Trujillano Ruiz ◽  
MA Morego Soler ◽  
V Cano Collado ◽  
MA Maestre Fullana ◽  
...  
Keyword(s):  
Patient Care ◽  
Hospital Pharmacist ◽  
Patient Care Team ◽  
Care Team ◽  
Chronic Patient

scholarly journals Prescribing Empiric Antibiotics for Febrile Neutropenia: Compliance with Institutional Febrile Neutropenia Guidelines

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 83 ◽  
Author(s):  
Doaa Naeem ◽  
Majed Alshamrani ◽  
Mohammed Aseeri ◽  
Mansoor Khan
Keyword(s):  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Bacterial Infections ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Management Guidelines ◽  
Empiric Antibiotics ◽  
Inappropriate Use ◽  
Common Diagnosis ◽  
The Mean

Background: Febrile neutropenia (FN) is an oncologic emergency which should be treated immediately with empiric antibiotics. Different institutions observe different antibiograms and use different FN management guidelines. Our center implemented FN management guidelines for adult cancer patients in 2009. Hence, we decided to assess compliance with FN management guidelines and to describe the pattern of bacterial infections. Method: We conducted a cross-sectional study on all adult cancer patients admitted with FN. Data were collected from electronic medical records between January and December 2014. Results: One hundred FN episodes met the study inclusion criteria. The mean age of the patients was 41 ± 17 years; 52% (52 patients) were women. The most common diagnosis was lymphoma (33%). In terms of compliance to institutional FN guidelines, 55% of patients received guideline non-compliant treatment. The most common non-compliant treatment was incorrect amikacin dosing in 31% of patients, followed by incorrect vancomycin dosing in 20%, incorrect piperacillin/tazobactam dosing in 19%, inappropriate use of carbapenems in 18%, and non-compliant vancomycin use in 12% of patients. Bacterial isolates were only observed in 19% of the FN episodes. Among these 19 episodes of FN, Gram-negative pathogens were predominant and were identified in 74% of the episodes, followed by Gram-positive pathogens in 16% and polymicrobial pathogens in 10%. The mean time to defervescence was 2.21 ± 2 days. Conclusion: Our study concluded that there was a high percentage of non-compliance with our institutional FN management guidelines. We recommend following appropriate empiric antibiotic doses and indications as per institutional guidelines.

Chemotherapy-induced neutropenia among breast cancer patients presenting to a tertiary hospital in Nigeria.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12523-e12523
Author(s):  
Omolola Salako ◽  
Kehinde Sharafadeen Okunade ◽  
Adeoluwa Akeem Adeniji ◽  
Gabriel Fagbenro ◽  
Oluwasegun Afolaranmi
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Complete Blood Count ◽  
Routine Practice ◽  
Breast Cancer Patients ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Chemotherapy Induced Neutropenia

e12523 Background: Neutropenia and febrile neutropenia are major dose-limiting adverse effects of systemic cancer chemotherapy. It has been associated with significant morbidity and mortality, and high costs of management, and treatment breaks in cancer patients especially in resource-limited environments leading to poorer outcomes. Chemotherapy-induced neutropenia is an established complication of breast cancer treatment, however, there is paucity of information on the exact magnitude of the condition. This study assessed the prevalence of neutropenia and febrile neutropenia, while identifying their associated factors. Methods: A cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a two-year period. Sociodemographic, clinical and haematological data was obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected after each course of chemotherapy. The National Cancer Institute Common Terminology CTCAE version 4.03 was used to assess febrile neutropenia, neutropenia and its severity. Results: The prevalence of neutropenia and febrile neutropenia among the patients was 31.9% and 5.3% respectively. Throughout all courses of chemotherapy, there were neutropenic episodes 11.4% (57/502) with mild neutropenia 6.6%, moderate 3.4% and severe 1.4%. Prevalence of neutropenia decreased with increasing chemotherapy courses, with prevalence after first course being 14.2% and last course 4.9%. Associated risk factors for developing neutropenia include increasing age ( p = 0.014), ECOG performance score > 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002). Conclusions: One in three breast cancer patients developed neutropenia while on chemotherapy. The use of prophylactic G-CSF after each course of chemotherapy should be a routine practice, especially among elderly patients, unstable patients, and those with bone metastasis.

scholarly journals Empecilhos e soluções para relação médico-enfermeiro: revisão narrativa / Obstacles and solutions for medical-nurse relationship: narrative review

2020 ◽  
Vol 65 (1) ◽  
pp. 1
Author(s):  
Mateus Da Silveira Cespedes ◽  
José Carlos Rosa Pires de Souza ◽  
Suellem Luzia Costa Borges
Keyword(s):  
Patient Care ◽  
Patient Care Team ◽  
Narrative Review ◽  
Care Team ◽  
Care Hospital ◽  
Hospital Organization ◽  
High Turnover ◽  
Good Doctor ◽  
External Pressures ◽  
Hospital Organization And Administration

Objetivos: Identificar e descrever os empecilhos e as soluções para a boa relação médico-enfermeiro. Métodos: trata-se de uma revisão narrativa da literatura com 10 estudos entre 2006 e 2018 que apresentavam como descritores “Relações Médico-Enfermeiro” e “Equipe de Assistência ao Paciente”, cuja pergunta norteadora foi quais os empecilhos e soluções para uma boa relação médico-enfermeiro? Resultados: encontraram-se como empecilhos: déficits na comunicação, pontos de vista conflitantes, alta rotatividade, pressões externas, funções ambíguas, conflito de tarefa, hierarquia, conhecimento técnico e hostilidade prévia. As soluções encontradas foram: redução da carga horária, melhora da estrutura, troca de informações frequentes e sucintas, estímulo às discussões de casos clínicos e propostas terapêuticas conjuntas, valorização dos profissionais mais antigos, delimitação clara da autoridade, responsabilidade e competência de cada profissional, manutenção de relação afetuosa extra-profissional, confiança e valorização dos profissionais. Conclusão: é necessário delimitar os fatores de piora na relação e pôr em prática as soluções oferecidas para desenvolver os profissionais e proporcioná-los melhor ambiente de trabalho.Palavras Chave: Relações médico-enfermeiro, Equipe de assistência ao paciente, Administração hospitalar, Corpo clínico hospitalar, Planejamento hospitalar ABSTRACT:Objectives: To identify and describe the obstacles and solutions for a good doctor-nurse relationship. Methods: it is a narrative review of the literature with 10 studies between 2006 and 2018 that presented as descriptors "Doctor-Nurse Relations" and "Patient Care Team", whose guiding question was what are the obstacles and solutions for a good relationship nurse-doctor? Results: found as impediments: deficits in communication, conflicting points of view, high turnover, external pressures, ambiguous functions, task conflict, hierarchy, technical knowledge and previous hostility. The solutions found were: reducing the workload, improving the structure, exchanging frequent and succinct information, encouraging discussions of clinical cases and joint therapeutic proposals, valuing the oldest professionals, clearly defining the authority, responsibility and competence of each professional, maintenance of an extra-professional affectionate relationship, trust and valorization of the professionals. Conclusion: it is necessary to delimit the factors that worsen the relationship and put into practice the solutions offered to develop professionals and provide them with a better work environment.Key words: Physician-nurse relations; Patient care team; Hospital administration; Teams, health care; Hospital organization and administration

scholarly journals E-Mail Communication Practices and Preferences Among Patients and Providers in a Large Comprehensive Cancer Center

2016 ◽  
Vol 12 (7) ◽  
pp. 676-684 ◽  
Author(s):  
Natalie Cook ◽  
Manjula Maganti ◽  
Aditi Dobriyal ◽  
Michal Sheinis ◽  
Alice C. Wei ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Health Care Team ◽  
Care Team ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Impact ◽  
E Mail

Purpose: Little is known about how electronic mail (e-mail) is currently used in oncology practice to facilitate patient care. The objective of our study was to understand the current e-mail practices and preferences of patients and physicians in a large comprehensive cancer center. Methods: Separate cross-sectional surveys were administered to patients and physicians (staff physicians and clinical fellows) at the Princess Margaret Cancer Centre. Logistic regression was used to identify factors associated with current e-mail use. Record review was performed to assess the impact of e-mail communication on care. Results: The survey was completed by 833 patients. E-mail contact with a member of the health care team was reported by 41% of respondents. The team members contacted included administrative assistants (52%), nurses (45%), specialist physicians (36%), and family physicians (18%). Patient factors associated with a higher likelihood of e-mail contact with the health care team included younger age, higher education, higher income, enrollment in a clinical trial, and receipt of multiple treatments. Eighty percent of physicians (n = 63 of 79) reported previous contact with a patient via e-mail. Physician factors associated with a greater likelihood of e-mail contact with patients included older age, more senior clinical position, and higher patient volume. Nine hundred sixty-two patient records were reviewed, with e-mail correspondence documented in only 9% of cases. Conclusion: E-mail is commonly used for patient care but is poorly documented. The use of e-mail in this setting can be developed with appropriate guidance; however, there may be concerns about widening the gap between certain groups of patients.

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