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Dose Intensity in Early-Stage Breast Cancer: A Community Practice Experience

Fairfax Northern Virginia Hematology Oncology, Fairfax, VA

Corresponding author: Robert L. Bretzel Jr, RPh, Fairfax Northern Virginia Hematology Oncology, 8503 Arlington Blvd, Ste 400, Fairfax, VA 22031; e-mail: robert.bretzel{at}usoncology.com.

Purpose: This retrospective study was a quality initiative to determine practice patterns in adjuvant chemotherapy for early-stage breast cancer (ESBC) and define the incidence and causative factors of suboptimal relative dose intensity (RDI). Our community-based practice participates in ASCO's Quality Oncology Practice Initiative in an effort to improve the quality of care provided to our patients. Most metrics do not have a direct proven correlation with improvement in survival, but measurement of RDI does.

Patients and Methods: Our study was a retrospective analysis of patients with ESBC. Each patient was treated on an outpatient basis in a community practice setting. We used the diagnosis criteria of breast cancer to create a list of eligible patients within the data range from our electronic medical record. Inclusion criteria consisted of all women seen in our offices receiving adjuvant chemotherapy for a diagnosis of breast cancer. Exclusion criteria included patients with metastatic disease and patients not receiving chemotherapy.

Results: The average weighted RDI for all patients was 98.4%. Of the 834 evaluable patients we reviewed, 102 patients (12.2%) had some reduction in RDI. This subset had an average RDI of 88%. Twenty-nine patients (3.5%) had an RDI of less than 85%.

Conclusion: Because decreased RDI has been shown to correlate with decreased overall and disease-free survival rates, we were compelled to measure and determine causative factors in our patients with ESBC. The primary reasons for dose delay and overall reduction in RDI were scheduling and neutropenia. Scheduling delays were initiated by both patients and medical staff, with the majority requested by patients.

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