WASHINGTON, DCRecombinant human erythropoietin is accepted treatment
for chemotherapy-related anemia, but a panel of four oncology nurses
convened to review an evidence-based clinical practice guideline for anemia
concluded that guidelines are not being consistently followed. The panel’s
findings were presented by Denise Oseguera, RN, of University of California,
Los Angeles, and Susan Ross, MD, of MetaWorks Inc., Medford, Massachusetts.
The panel identified major barriers to and benefits of implementing
guidelines and pointed to clinic nurses as key to improving management of
anemia in cancer patients. "Oncology nurses are often the first
caregivers with the opportunity to assess anemia in cancer outpatients. The
success or failure of implementation of any ‘global’ clinical practice
guideline hinges on removing local barriers and emphasizing local
benefits," Ms. Oseguera said. "In oncology clinic settings, nurses
are the key implementersknowledgeable about practice-specific
circumstances and equipped to champion process improvements."
Treatment Triggers Vary
The panel of four oncology nurses represented disparate practice settings
in Los Angeles, Salt Lake City, St. Louis, and Minneapolis. "Outpatient
oncology practice is heavily dependent upon nurses as both patient advocates
and front-line care providers. Success of guidelines in this setting depends
on identifying and addressing issues unique to nurses," Ms. Oseguera
The guideline for the treatment of chemotherapy-related anemia focused on
the use of erythropoietin and was developed by a multidisciplinary panel
following a systematic review of the literature through August 2000. The
study to review the guideline was funded by Amgen.
The panel found that triggers for anemia treatment varied greatly at the
different geographical locations (see Table 1). Panel members said that
implementing the anemia guideline would improve care, reduce error, reduce
direct and indirect transfusion-associated costs, improve adherence to
chemotherapy schedules, and improve workflow.