Do Neutrophil Counts Pre-chemotherapy Treatment provide Clinical Value.


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Pinkie Chambers1,Li Wei2,Yogini Jani3,Ian Wong4
1UCLH NHS Foundation Trust,2UCL School of Pharmacy,3UCL/UCLH Centre for Medicines Optimisation Research and Education,4UCL Research Department of Pharmacy Practice

Abstract

Background

As chemotherapy patient numbers have increased, treatment pathways in the UK have adapted to maximise capacity. A strategy commonly adopted is one whereby a patient will have blood tests on a separate day to chemotherapy to ensure neutrophil count recovery has been achieved. In many cases this is duplicated again on the day of treatment. We aimed to understand the proportion of patients that had received these duplicate tests and the value this provided to care.

Method

We extracted a dataset from the chemotherapy electronic prescribing system at one tertiary referral cancer hospital from January 2016-January 2018. We included patients aged 18 and over, receiving first line therapy for diffuse large B-cell lymphoma, colorectal cancer (adjuvant) and early breast cancer. Data were extracted for age, treatment and neutrophil counts with corresponding dates.  Descriptive statistics were used to analyse the difference between duplicate blood results and those taken pre-cycle 2 chemotherapy using STATA version 15.1.

Results

300 patients were included. 212/300 patients were female and the median age of the whole sample was 55 (range 21-83).  The mean baseline neutrophil count was 4.7 (SD 2.748123).  We found that 147/300 (49%) patients had received two blood tests within 6 days of chemotherapy administration; of these 37 (25%) were repeated as the neutrophil count taken was below the required threshold value to allow treatment. Of those with neutrophils above the threshold, 71% (79/110) were found to have a lower count value on the day of treatment than that taken 5/6 days prior.  In 7 cases the neutrophil value was below 1.2x109 /L .  In all cases cycle 2 was safely administered.

Conclusion

We have demonstrated that duplication of blood tests does occur, however the value is unclear.  We have showed evidence of potential delayed nadir occurring in patients but this may not be of clinical significance.