Impact of evidence-based nursing on clinical outcomes in patients with leukemia undergoing chemotherapy.

Purpose: This study aimed to evaluate whether evidence-based nursing interventions were associated with clinical outcomes in patients with leukemia undergoing chemotherapy and to support the development of optimized nursing strategies for hematologic oncology patients. Methods: This observational, single-center retrospective cohort study was conducted in the Pingyang Hospital Affiliated to Wenzhou Medical University, and was reported in accordance with the STROBE statement for observational studies. Adult patients with acute leukemia who underwent chemotherapy between February 2022 and February 2025 were screened using retrospective consecutive sampling according to predefined inclusion and exclusion criteria. Patients were classified according to the nursing model documented in electronic medical records: the conventional nursing group (n = 86) included patients treated from February 2022 to June 2023, when conventional nursing was the routine departmental nursing model, whereas the evidence-based nursing group (n = 91) included patients treated from July 2023 to February 2025, after a department-level evidence-based nursing pathway had been adopted in routine clinical practice. No patients were prospectively allocated to nursing interventions for the purpose of this study. Chemotherapy-related complications and SAS, SDS, ARMS, and SF-36 scores were extracted from medical records and routine nursing assessments. Separate binary logistic regression models were used to examine factors associated with infection, nausea/vomiting, and oral mucositis. Results: Compared with the Conventional group, the evidence-based group had lower incidences of infection (25.27% vs 41.86%, P = 0.019), nausea/vomiting (39.56% vs 65.12%, P < 0.001), and oral mucositis (17.58% vs 44.19%, P < 0.001). No significant between-group differences were observed for bleeding, bone marrow suppression, or phlebitis. Post-intervention SAS, SDS, and ARMS scores were lower in the evidence-based group, whereas SF-36 scores were statistically higher; however, the median between-group difference in SF-36 was modest (51.00 vs 47.50). In multivariable models, evidence-based nursing was associated with lower odds of infection (OR = 0.49, 95% CI: 0.25-0.96), nausea/vomiting (OR = 0.38, 95% CI: 0.20-0.73), and oral mucositis (OR = 0.31, 95% CI: 0.15-0.63). Conclusion: Compared with conventional care, evidence-based nursing was associated with lower rates of selected chemotherapy-related complications, lower anxiety and depression scores, better treatment adherence, and a modest increase in SF-36 scores among leukemia patients undergoing chemotherapy. Because this was a single-center retrospective before-after study, these findings should be interpreted as associations rather than definitive causal effects. Patients with poor ECOG status, abnormal WBC counts, or repeated chemotherapy cycles may require more intensive risk assessment and stratified nursing management.