Virginia Cancer Specialists Study Measuring Effects of Chemotherapy Dosing Schedule Published in Journal of Oncology Practice

Fairfax, VA, October 19, 2009 - Data from a study published in the November 2009 Journal of Oncology Practice details Fairfax Northern Virginia Hematology Oncology’s (FNVHO) initiative to put a quantitative value on quality by measuring the incidence and causes of substandard relative dose-intensity (RDI) among its patients with early stage breast cancer (ESBC).

RDI compares the actual dose and schedule of chemotherapy delivered to the intended dose and schedule of the standard chemotherapy regimen.  While most metrics do not have a direct proven correlation with improvement in survival, measuring RDI does. Although controversial, the relationship between dose intensity of chemotherapy and patient outcomes is well documented in literature, and several studies discuss the significance of achieving more than 85 percent RDI. This data shows that failure to maintain 85percent, the patient’s survival rate is similar to those who never received chemotherapy.  

Evidence continues to confirm that maintaining dose intensity for certain types of cancer increases disease-free survival and overall survival rates when the RDI is greater than 85%.  The recent study published showed FNVHO with an RDI of 98.4 percent.  “Prior to this initiative, RDI was not routinely calculated for our ESBC patients,” says Robert Bretzel, a lead author of the study.  “However, since decreased RDI has been shown to correlate with decreased overall survival and disease-free survival, we were compelled to measure and determine the causative factors.”

Using a practice-wide electronic medical record (EMR), FNVHO retrospectively evaluated its experience of 834 patients in its large community-practice setting. For the purpose of this study, FNVHO focused on the subset group that showed a reduction in RDI.  The practice reviewed data from eight of its treatment sites to determine trends by site.  FNVHO also measured the average RDI in this subset by physician to determine trends. 

Among its findings, the study showed:

• The average weighted RDI for all patients was 98.4 percent;
• Of the 834 evaluable patients FNVHO reviewed, 102 patients (12.2 percent) had some reduction in RDI. This subset had an average RDI of 88 percent; and
• Twenty-nine patients (3.5 percent) had a RDI of less than 85 percent.

The most common reasons FNVHO noted for dose delay were:

• Scheduling (both patient and medical reasons);
• Neutropenia (an abnormally low number of a type of white blood cells called neutrophils);
• Treatment toxicity; and
• Infection.

Sixty-five percent of scheduling delays were due to patient decision as opposed to office decision. 
FNVHO also studied the cause of delays due to risk factors.  Sixty percent of patients had no risk factors other than being female.  Chronic disease and low hemoglobin were also noted as causes of dose delays.

Of the patients that were treated within the data range, FNVHO used its EMR to determine which subset of these patients experienced dose delays and/or dose reductions during their adjuvant (precautionary treatment given after surgery) chemotherapy treatments by reviewing individual charts. The data from the subset of patients with reduced dose delays/dose reductions were then entered into a RDI calculator, a software program written and supported by NearSpace. 
 “As part of a new quality initiative, we are translating this to other cancer types and will continue to measure RDI so that we can optimize patient outcomes, prevent recurrent disease, and understand the factors that cause reductions to RDI in our community-based practice,” says Dr. Anne Favret, an oncologist at FNVHO.

About FNVHO
Fairfax Northern Virginia Hematology Oncology (FNVHO) is northern Virginia’s premier oncology and hematology practice of board certified physicians.  The practice has 33 physician experts on cancer, blood disorders and stem-cell transplantation in seven locations across northern Virginia.  Comprehensive practice services include collaborative nursing, financial counseling and access to cutting-edge clinical trials through affiliations with US Oncology, the National Cancer Institute and many other cooperative groups.  For more information, visit www.fnvho.com.