Development and practice of a standardized management pathway for chemotherapy-induced neutropenia in patients with gynecological malignancies.

backgroundChemotherapy-induced neutropenia (CIN) is the most common type of myelosuppression in patients undergoing chemotherapy. It can lead to chemotherapy dose reduction, treatment delays, diminished antitumor efficacy, reduced quality of life, and increased healthcare burden. Although various guidelines have been established domestically and internationally to standardize the management of CIN, their effectiveness in controlling its incidence remains limited. PURPOSE: This study aimed to evaluate the role of a standardized management pathway in the management of CIN and its impact on chemotherapy-related adverse events and satisfaction among gynecological cancer patients.

methodsA total of 230 patients receiving conventional management from July to December 2024 were selected as the control group, while 230 patients managed under the CIN standardized pathway from January to June 2025 were enrolled as the intervention group. The CIN standardized management pathway integrated functions such as febrile neutropenia (FN) risk calculation, visual risk stratification alerts, intelligent decision support for prophylactic medication, multi-approach health education, and cloud-based follow-up. Comparisons were made between the two groups regarding hematological toxicity markers (ANC, WBC), incidence of chemotherapy-related adverse events (FN, chemotherapy delay, and dose reduction), FN risk assessment compliance rate, and patient satisfaction.

resultsAfter three chemotherapy cycles, unadjusted comparisons showed more favorable ANC and WBC distributions in the intervention group than in the control group (all P < 0.001). However, adjusted analyses did not show statistically significant associations with grade 3-4 ANC reduction or grade 3-4 WBC reduction. The FN risk-assessment compliance rate reached 100% in the intervention group, higher than the 54.6% observed in the control group (P < 0.001). The observed incidence of FN was lower in the intervention group than in the control group (1.4% vs. 8.3%; P = 0.002), although FN was analyzed descriptively. The intervention was associated with lower adjusted odds of chemotherapy delay and dose reduction and with higher adjusted patient satisfaction scores.

conclusionThe standardized CIN management pathway was associated with favorable changes in hematologic toxicity indicators, chemotherapy-related adverse events, and patient satisfaction. Further multicenter randomized or cluster-randomized studies are needed to confirm these findings.