Knowledge, attitude, and practice toward chemotherapy-related neutropenia and febrile neutropenia among breast cancer patients Running title: KAP of chemotherapy neutropenia in breast cancer

Abstract

Abstract Aims This study aimed to investigate the knowledge, attitude, and practice (KAP) toward chemotherapy-related neutropenia and febrile neutropenia (FN) among breast cancer patients. Materials and methods A multi-center cross-sectional study enrolled breast cancer chemotherapy patients at four hospitals between April and June 2023. A self-administered questionnaire was developed to assess KAP scores. The structural equation model (SEM) was used to analyze the interactions between patients' knowledge and attitude and demographic characteristics. Results A total of 246 patients completed the questionnaire. The mean knowledge score was 12.46 ± 6.21 (possible range: 0–26) and the mean attitude score was 30.00 ± 2.58 (possible range: 7–35). Less than half of the patients knew whether their chemotherapy protocol was a high-risk protocol for FN (45.95%). However, the majority of patients were aware of the need for the prophylactic administration of leukocyte-raising agents (79.67%). Multivariate logistic regression analysis showed that junior college and above (OR = 4.69, 95% CI = 2.23–9.89, P < 0.001) was associated with adequate knowledge. Living in urban areas (OR = 0.58, 95% CI = 0.34–0.97, P = 0.037) was associated with positive attitude. The SEM showed that experience with chemotherapy-related neutropenia or FN had a direct effect on knowledge (β = 1.77, p = 0.029). Conclusion This study found inadequate knowledge, positive attitude and suboptimal practice toward chemotherapy-related neutropenia and FN among breast cancer chemotherapy patients. Tailored and effective education programs need to be designed and implemented to improve relevant KAP in this patient population.