การพัฒนาและประเมินผลของแนวทางการจัดการภาวะเม็ดเลือดขาวนิวโทรฟิลต่ำร่วมกับมีไข้ในผู้ป่วยมะเร็งชนิดก้อนที่ได้รับยาเคมีบำบัด โรงพยาบาลน่าน

Abstract

This study aimed to develop and evaluate the management protocol for febrile neutropenia in solid tumor patients receiving chemotherapy at Nan hospital. The study consisted of 3 phases. Phase 1 was a descriptive study aimed to study the prevalence of febrile neutropenia in solid tumor patients receiving chemotherapy at Nan hospital from August to October 2019. After that the action research was done to develop the management protocol for febrile neutropenia in solid tumor patients receiving chemotherapy. A focus group discussion was conducted with a healthcare team in May 2020. Phase II was the 2-week run-in period of the management protocol for febrile neutropenia in solid tumor patients receiving chemotherapy. Finally, phase III was a quasiexperimental research method to evaluate the management protocol for febrile neutropenia in solid tumor patients receiving chemotherapy at Nan hospital during August to October 2019 and June to August 2020. The samples were solid tumor patients receiving chemotherapy before (from August to October 2019) and after (from June to August 2020) implementing the management protocol of febrile neutropenia. The prevalence of febrile neutropenia in these patients was compared between the two periods using the Fisher’s exact test with a significant level of less than 0.050. For phase I, the revalence of febrile neutropenia was 3.2% in a 3-month period (3 febrile neutropenia of 94 solid tumor patients). A focus group discussion with a healthcare team (four physicians, two pharmacists and two nurses) on 3 April 2021 at chemotherapy, Nan hospital, resulted in developing a management protocol of febrile neutropenia in solid tumor patients receiving chemotherapy at Nan hospital. This management protocol included three processes: 1) risk assessment of febrile neutropenia in patients with absolute neutrophil count (ANC) less than 1,500 cell/mm3 for at least two times; 2) prevention of febrile neutropenia by providing granulocyte colony stimulating factor (G-CSF) to patients with ANC less than 1,500 cell/mm3 for at least two times; and 3) monitoring febrile neutropenia in the hospital in conjunction with prescribing G-CSF to patients with ANC lower than 500 cell/mm3. For phase II, the health care team adopted the management protocol for febrile neutropenia in solid tumor patients receiving chemotherapy. For phase III, after implementing the management protocol for 3 months, the prevalence of febrile neutropenia in solid tumor patients receiving chemotherapy decreased from 3.2% (3 febrile neutropenia of 94 solid tumor patients) to 0.9% (1 febrile neutropenia of 104 solid tumor patients). However, it was not a significant difference (P = 0.338).

In conclusion, the health care team's management protocol for febrile neutropenia in solid tumor patients receiving chemotherapy reduced the prevalence of febrile neutropenia, but the reduction was not significant. As a result, a review of this management technique is still required to make it more effective.