Relative Dose Intensity: Improving Cancer Treatment and Outcomes

Purpose/Objectives: To determine the incidence of and reasons for chemotherapy dose delays or reductions.

Design: A performance improvement initiative formed the basis for a prospective nursing research study.

Setting: A single institution in western Pennsylvania.

Sample: 204 patients scheduled for nonmyeloablative chemotherapy.

Methods: Data collection forms were completed by RNs and evaluated by an interdisciplinary team.

Main Research Variables: Rates of nonadherence to chemotherapy schedule or dosing and associated reasons.

Findings: The performance improvement initiative revealed evidence of nonadherence to chemotherapy schedule or dosing when patient-requested cancellations and physician-ordered dose delays and reductions were left unchallenged and medical and nursing staffs had limited knowledge of or interest in relative dose intensity. The ensuing nursing research study found that less than 51% and 78% of patients adhered to their schedule and dosage, respectively. Nonadherence primarily was attributed to canceled visits, suboptimal or nonuse of hematopoietic growth factors, and routine dose reductions. Subsequent educational initiatives targeting the interdisciplinary team and patients and their families focused on the importance of keeping scheduled visits and preventing versus managing pancytopenia. Adopting a telephone referral procedure and distributing a patient education sheet reduced patient cancellations by 50%. Various reasons for dose delays and reductions have surfaced, many of which are modifiable with educational efforts.

Conclusions: A knowledge deficit was found among patients and healthcare providers regarding the importance of adhering to chemotherapy orders.

Implications for Nursing: Evaluating patterns of chemotherapy administration and educating patients, nurses, and physicians will have an impact on relative dose intensity, potentially improving treatment outcomes.