Evidence to guide the optimal timing for pre‐chemotherapy blood tests for early breast, colorectal cancer and diffuse large B‐cell lymphoma

Abstract

Background Re‐designing services and processes to meet growing demands in chemotherapy services is necessary with increasing treatments. There is little evidence guiding the timing and thresholds to be attained of pre‐chemotherapy blood assessments, namely neutrophils. Methods A survey was developed and distributed to health professionals in the United Kingdom (UK) to examine current practice in timing and threshold values of neutrophils and platelets before treatment administration. This was followed by a retrospective cohort study, using data from electronic patient record systems; including patients initiating treatment between January 2013 and December 2018, to determine a safe timeframe for blood assessments; comparing neutrophil, platelet, creatinine and bilirubin levels at different time points. Results The survey captured 25% of hospitals in the UK and variations were apparent in both the timing of assessments and thresholds needed, particularly for neutrophils. 616 (6.5%) of 4007 patients included had neutrophil levels measured twice within 7 days of treatment (with the first level taken beyond 3 days and the second test being within 3 days of treatment‐ the UK standard). Of the patients that attained an acceptable neutrophil level at their first test, five of the 616 (0.8%) became ineligible for administration from the test 2 level. 23% of patients improved their grade and became eligible for treatment. Little difference was observed for platelets. Conclusions We have demonstrated that extending the timeframe for blood tests can be safe, however, this practice may cause unnecessary delays for patients if only an early test is relied on for eligibility.

Development and validation of a risk score (Delay-7) to predict the occurrence of a treatment delay following cycle 1 chemotherapy

“…Finally, through our investigations of variables we uncovered differences in hospitals and their rates of delays, meaning that simple alignment to both operational and clinical procedures such as appropriate threshold setting for haematological toxicity could result in reduced delays. 24 We believe that through a combination of alignment of policies and tailoring toxicity support through use of our model, we will improve the relative dose intensity of treatments received.…”

Hilab System Device in an Oncological Hospital: A New Clinical Approach for Point of Care CBC Test, Supported by the Internet of Things and Machine Learning

“…Additionally, it is relevant to emphasize that oncological patients undergoing chemotherapy need minimal values in specific CBC analytes to realize the procedure. Thus, routine pre-chemotherapy blood tests should be undertaken 2-3 days before the treatment to avoid unwarranted delays [34]. Therefore, the fast and less painful Hilab CBC test may represent an essential advantage for these patients and the hospital routine.…”

Personalising monitoring for chemotherapy patients through predicting deterioration in renal and hepatic function

“…Routine clinical practice is to assess kidney and liver function prior to each treatment cycle 4 ; however, the value of this process with respect to detecting significant changes that necessitate chemotherapy dose modifications is uncertain. Where patients are very unlikely to experience significant changes in renal and hepatic function during chemotherapy, monitoring at every cycle may be unnecessary, and for many patients involves increased waiting times and unnecessary blood tests 5 .…”