What is the role of interval blood testing in the management of chemotherapy for gynecologic malignancies

Purpose: To determine the safety of omitting routine interval laboratory assessments, dietary restrictions, and isolation precautions between cycles of chemotherapy for gynecologic malignancies.

Methods: Data were retrospectively obtained from the records of women receiving chemotherapy for gynecologic cancer from July 1999-June 2000. Routine nadir determinations were not performed between treatment cycles; social interaction was encouraged, and pathogen-free diet recommendations were not provided.

Results: Eighty women received 449 cycles of chemotherapy. Four (5%) patients developed neutropenic fevers, and one of these women succumbed to sepsis. Eighteen (22.5%) women had 29 cycles delayed due to persistent myelosuppression when the ensuing chemotherapy infusion was to be administered. Hematopoietic growth factors overcame these delays during subsequent cycles in all but two patients.

Conclusion: Omitting scheduled interval laboratory monitoring, dietary restrictions, and isolation precautions between chemotherapy cycles is convenient for patients, likely cost-effective, and does not increase morbidity in the gynecologic oncology population.

Chemotherapy; Toxicity; Gynecologic oncology; Neutropenia

[1] Neijt J. P., Engeholm S. A., Tuxen M. K. et al.: "Exploratory phase III study of paclitaxel and cisplatin versus carboplatin in advanced ovarian cancer". J. Clin. Oneal., 2000, 18, 3084.

[2] Guastalla J.P., Pujade-Lauraine E., Weber B. et al.: "Efficacy and safety of the paclitaxel and carboplatin combination in patients with previously treated advanced ovarian carcinoma". Ann. Oncol., 1998, 9, 37.

[3] Curtin J. P, Hoskins W. J., Rubin S. C. et al.: "Chemotherapy induced neutropenia and fever in patients receiving cisplatin-based chemotherapy for ovarian malignancy". Gynecol. Oneal., 1991, 40, 17.

[4] McMeekin D. S., Gazzaniga C., Berman M., DiSaia P., Manetta A "Retrospective review of gynecologic oncology patients with therapy induced neutropenic fever". Gynecol. Oneal., 1996, 62, 247.

[5] Carlson J. W., Fowler J. M., Mitchell S. K., Carson L. F., Mayer A. R., Copeland L. J.: "Chemoprophylaxis with ciproflowacin in ovarian cancer patients receiving paclitaxel: a randomized trial". Gynecol. Oneal., 1997, 65, 325.

[6] Cruciani M., Rampazzo R., Malena M. et al.: "Prophylaxis with fluoroquinolones for bacterial infections in neutropenic patients: a meta-analysis". Clin. Infect. Dis., 1996, 23, 795.

[7] Verhoef J.: "Prevention of infections in the neutropenic patient" Clin. Infect. Dis., 1993, 17 (Suppl. 2), S359.

[8] Hartmann L. C., Tschetter L. K., Habermann T. M. et al.: "Granulocyte colony stimulating factor in severe chemotherapy induced afebrile neutropenia". N. Engl. J. Med., 1997, 336, 1776.

[9] Crawford J., Ozer H., Stoller R. et al.: "Reduction by granulocyte colony stimulating factor of fever and neutropenia induced chemotherapy in patients with small cell lung cancer". N. Engl. J. Med., 1991, 325, 164.

[10] Morstyn G., Gampbell L., Souza L. M. et al.: "Effect of granulocyte colony stimulating factor on neutropenia induced by cytotoxic chemotherapy". Lancet, 1998, 1, 667.

[11] Ohno R., Tomonaga M., Kobayashi T. et al.: "Effect of granulocyte colony stimulating factor after intensive induction therapy in relapsed or refractory acute leukemia". N. Engl. J. Med., 1990, 323, 871.

[12] 2000 update of recommendations for the use of hematopoietic colony stimulating factors: evidence-based, clinical practice guidelines. J. Clin. Oneal., 2000, 18, 3558.