Evaluating and Enhancing the Current Guideline Adherence in prevention and treatment of cancer-related infections in Najaf.


  • Asan F Awad, Ayad A Ameen, Ammar R Mohammad


cancer, chemotherapy, infection, guideline, adherence, clinical pharmacist.


Background: Cancer patients receiving systemic antineoplastic therapy  are at risk for invasive infection. Since the magnitude of the neutrophil-mediated component of the inflammatory response may be muted in neutropenic patients, a fever may be the earliest and only sign of infection. The sign and symptom of infection are often absent or muted in in the absence of neutrophil but fever remains an early but non specific sign. 50%-60% of febrile patients have an established or occult infection. The NCCN (national comprehensive cancer network) Guidelines provide a summary of infection risk categories. Poor guideline adherence may lead to in ability to recognize neutropenic fever early and to initiate empiric systemic antibacterial therapy promptly in order to avoid progression to a sepsis syndrome and possibly death.  On the other hand, Poor guideline adherence increases unnecessary empirical therapy.

Aim of the study:

Assessment of the current practice followed by oncologists in prevention and treatment of cancer related infections in oncology center of Najaf and evaluation of the impact of pharmacist educational intervention in improving adherence to guideline of prevention and treatment of cancer-related infections.

Methods: An educational, interventional study based on validated questionnaire was conducted at (Middle Euphrates cancer center / An-Najaf governorate/ Iraq). The questionnaires were personally delivered to all specialized (9) oncologists who were working at Middle Euphrates cancer center. A second study tool; sixty patients were included to check the existing practice of anti-infections prophylaxis, and patients’ outcomes. After the study intervention, the questionnaires were redistributed to the same participants to see if there was any change regarding their knowledge about cancer related infections and its prevention. Also, another sixty patients were enrolled to analyze the change in doctors’ practice toward cancer related infections prophylaxis and the possible improvements in patients’ outcomes.

Results: There were 9 oncologists completed the study with 100% response rate. Significant change was noticed in the participants’ knowledge toward all aspects of prevention and treatment of cancer related infections. The mean total overall knowledge scores out of (30) of all questionnaire parts increased considerably from 18.1± 3.2to 24.9± 1.6  after intervention, Also, Overall mean total score of participants about Knowledge of Risk factors of Cancer-Related Infections with good knowledge increased from only (10.2) of participants had good overall knowledge to (11.8) after intervention. The overall rate of Prescribing antimicrobial agent for cancer-related infections increased significantly in the post intervention group, (4.9) compared to (2.0) before intervention. Furthermore, the Proportional of overall good level of adherence in prevention and treatment of cancer-related infections to the guideline raised significantly (66.7%) before intervention vs. (100%) after intervention. In contrast, the Proportional of overall inadequate level of Adherence has been greatly reduced from 33.3% before intervention to 0.0% after intervention.

Conclusions: The clinical pharmacist's multifaceted intervention resulted in encouraging guideline implementations, as evidenced by improved knowledge about the prevention and treatment of cancer-related infections, as well as encouragement on the proper use of antimicrobial agents for cancer-related infections, according to this study.