Improving compliance with NCCN guidelines for anemia evaluation among gynecologic oncology patients

Abstract

<h3>Objectives:</h3> Our objective was to determine the prevalence of anemia and to improve compliance with the National Comprehensive Cancer Network (NCCN) recommendations to evaluate and treat anemia among gynecologic oncology patients. <h3>Methods:</h3> We conducted a prospective healthcare improvement initiative to align our practice with NCCN recommendations. Our intervention included prospective monitoring of lab results of both new patients and patients undergoing chemotherapy. Providers were notified if their patient had hemoglobin ≤11 g/dL and a clinical pharmacist pended iron studies, B12, and folate labs for the provider to review and accept if appropriate. Baseline data from the pre-intervention cohort was collected from 1/1/19-12/31/19; posti-ntervention data was collected from 2/2/2020-7/31/20. The primary outcome was prevalence of anemia and the secondary outcome was compliance with anemia evaluation, including iron, b12, and folate studies. Unadjusted odds ratios (OR) were obtained from logistic regression analysis. <h3>Results:</h3> We identified a total of 422 patients, 270 in the baseline cohort (69 new and 201 chemotherapy patients), and 152 in the post-implementation cohort (55 new and 97 chemotherapy patients). Prevalence of anemia in the entire study population was N=33/124 (27%) among new patients and N=202/298 (68%) among chemotherapy patients. Among new patients presenting with anemia, compliance with recommendations for evaluation of anemia increased from 37% to 93%, OR 22.3 (95% CI 3.4-451.2; P=0.007). Among anemic patients undergoing chemotherapy, compliance with recommendations for evaluation of anemia increased from 46% to 91%, OR 12.2 (95% CI 5.29-33.2; P<0.001). In the post-implementation new patient cohort, N=13/14 (93%) underwent any anemia evaluation. Of those with iron evaluation, N=2/13 (15%) had absolute iron deficiency and N=1/13 (8%) had possible functional iron deficiency. Of those with nutritional evaluation, N=0/9 (0%) had B12 deficiency, and N=1/9 (11%) had folate deficiency. In the post-implementation chemotherapy cohort, N=61/67 (91%) underwent any anemia evaluation. Of those with iron evaluation, N=0/58 (0%) had absolute iron deficiency and N=2/58 (3%) had possible functional iron deficiency. Of those with nutritional evaluation, N=3/53 (6%) had B12 deficiency, and N=9/53 (17%) had folate deficiency. <h3>Conclusions:</h3> Anemia is common among gynecologic cancer patients. Implementation of a healthcare improvement program was associated with significant increases in compliance with NCCN guidelines for evaluation of anemia among gynecologic oncology patients.