Evaluating compliance of NCCN cancer and chemotherapy-induced anemia guidelines in a community healthcare setting.

Abstract

16 Background: The National Comprehensive Cancer Network has released guidelines for management of cancer- and chemotherapy-induced anemia which are defined as Hb less than 11g/dL or a greater than 2g/dL decrease from baseline. The myelosuppressive effects of cancer, chemotherapy and associated treatments, can accumulate with each cycle leading to severe and worsening anemia. It is important to properly identify and treat anemia in cancer patients in a timely manner. This project evaluates the degree to which NCCN guidelines are followed within a multi-site community healthcare setting. Methods: Obtained patient medical records within Hartford Healthcare system in a 4 month period (Nov. 2019-Feb. 2020), who were started on new cancer chemotherapy treatment plans. Patients on single agent immunotherapy or hormone therapy only plans were excluded. Reviewed patient’s medical records to identify who met criteria for cancer- and chemotherapy-induced anemia and who received recommended work up and treatment based on NCCN guidelines. Age, sex, disease, renal function, and goals of treatment were also recorded. Results: A total of 869 patient records were obtained. 598 patients met the inclusion criteria. 452 patients (75.6%) met criteria for cancer- and chemotherapy-induced anemia. 235 patients (52%) had anemia appropriately documented in the physician medical record. 111 patients with anemia (24.6%) had an iron panel performed and 29 patients (6.4%) had a reticulocyte count resulted. For those eligible by NCCN criteria for anemia specific interventions 27 patients (40%) received appropriate iron supplementation, 95 patients (85.6%) received appropriate blood transfusions and 10 patients (7.7%) received appropriate EPO. Conclusions: It is apparent that based on NCCN guidelines, monitoring, evaluation, and treatment of anemia is not being appropriately performed in this healthcare setting. Based on this data a quality improvement project for proper documentation, workup, and treatment of anemia is being developed. [Table: see text]