January 2002 Meeting Highlights

Dose Intensity and Clinical Outcomes in Cancer Chemotherapy

Debra Wujcik, RN, MSN, AOCN

The January CACONS educational meeting was presented by Debra Wujcik, RN, MSN, AOCN.

Dose intensity is a measure of total dose of chemotherapy delivered over time. Relative dose intensity describes the relationship of the actual dose of chemotherapy administered over a period of time to the desired dose to be given over the intended amount of time. The dose intensity is affected by decreasing the dose or increasing the time over which the dose is given.

In an ideal world, the patient with cancer gets 100% of the desired dose in the intended amount of time. Oncology nurses know that dose reductions and delays are common for several reasons including myelosuppression, vacations and planned events, and lack of communication regarding treatment goals.

There is increasing evidence that maintaining dose intensity for certain disease types increases the disease free and overall survival. One study by Bonnadonna had a 20-year follow up of 386 adjuvant breast cancer patients treated by surgery alone or surgery followed by adjuvant therapy with cyclophosphamide, methotrexate, and 5-FU. The study demonstrated survival significantly improved in patients receiving chemotherapy. Among patients receiving chemotherapy, those receiving >85% of the planned chemotherapy dose had improved disease free and overall survival, These patients receiving <65% of chemotherapy dose intensity had outcomes no better than patients treated by surgery alone.

Oncology nurses are in a critical role to influence the delivery of on time, full with doses of chemotherapy. First, the treatment goals should be clear to the patient and all health care providers. If the goal is cure or control, every effort should be made to maintain dose intensity

Next, the nurse can assess the treatment plan to determine the risk of myelosuppression. If the risk of neutropenia is >40%, filgrastim may be indicated with the first cycle of therapy. If the patient experiences neutropenia after treatment, filgrastim may be initiated with the next cycle of therapy. The nurse must ensure that the correct dose of filgrastim for the patient’s body weight is used and that it is administered correctly. Finally, the nurse can help the patient plan important events and needed breaks around the chemotherapy schedule, especially when the goal of treatment is cure.

Education