European Journal of Oncology Nursing (2005) 9, S14–S23 Neutropenia management with granulocyte colony-stimulating factors: From guidelines to nursing practice protocols Shelley Dolan a,Ã , Patrick Crombez b , Maria Munoz c a Royal Marsden NHS Trust, Fulham Road, SW36JJ, London, UK b Jules Bordet Institute, 1 rue He´ger Bordet, Brussels, Belgium c Department of Oncology-Haematology, Clinic University Hospital, Avenida Blasco Iban ˜ez 17, 46007 Valencia, Spain Summary Neutropenia, a problem that oncology nurses face in daily practice, is the major dose-limiting toxicity in patients with cancer who are treated with myelosuppressive chemotherapy. The incidence of chemotherapy dose reductions or treatment delays, which can impact overall dose intensity and compromise treatment outcomes, may be reduced by the proactive use of granulocyte colony- stimulating factor (G-CSF). National and international guidelines have been developed to promote the cost-effective use of G-CSF. Nursing care protocols for the management of chemotherapy-induced neutropenia (CIN) can be developed based on the national guidelines and modified for use by individual clinical practices. Risk assessment for CIN, which considers the prescribed chemotherapy regimen, patient risk factors, and treatment intent, should be a key component of the practice guidelines. Because most neutropenic events occur in the first cycle of chemotherapy, risk assessments should be conducted before the initiation of chemotherapy. Patients identified as at high risk for neutropenic complications should be given G-CSF in the first and subsequent cycles to allow the delivery of chemotherapy at full dose and on schedule. Nurses are instrumental in the development and implementation of neutropenia management protocols, which have the potential to markedly improve the quality of care and outcomes for patients with cancer. & 2005 Published by Elsevier Ltd. Zusammenfassung Neutropenien—ein Problem, mit dem onkologische Pflege- kra ¨fte in ihrer ta ¨glichen Praxis ha ¨ufig konfrontiert werden—bilden die wichtigste dosislimitierende Toxizita ¨t bei Krebspatienten, die eine myelosuppressive Chemother- apie erhalten. Die Inzidenz von Dosisreduzierungen oder Behandlungsverzo¨egerungen ARTICLE IN PRESS www.elsevier.com/locate/ejon KEYWORDS Neutropenia; Granulocyte colony- stimulating factor; Guidelines; NCCN; Risk assessment 1462-3889/$ - see front matter & 2005 Published by Elsevier Ltd. doi:10.1016/j.ejon.2005.08.006 Ã Corresponding author. Tel.: +44207 3528271. E-mail address: shelleydolan@btinternet.com (S. Dolan).