eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2026-07-22 19 3 72795 article Vinod Kumar Mugada 1 Vidyadhara Suryadevara 3 Acharya Nagarjuna University College of Pharmaceutical Sciences, Guntur, AP, India. Department of Pharmacy Practice, Vignan Institute of Pharmaceutical Technology, Duvvada, AP, India. Department of Pharmaceutics, Chebrolu Hanumaiah Institute of Pharmaceutical Sciences, Guntur, AP, India. Ensuring systemic therapy is delivered at an adequate dose and schedule remains challenging. This study aimed to compare chemotherapy delivery quality in neoadjuvant (NAC) versus adjuvant (AC) settings and to identify predictors of suboptimal delivery and delay in dose for more than seven days. This was a 12-month observational study on treatment delivery evaluation. The study assessed planned versus delivered cycles, relative dose intensity (RDI), dose reductions, >7-day delays, early discontinuation, CTCAE v5.0 adverse events (per 100 cycles), and process metrics; multivariable models examined predictors of RDI <85% and delay >7 days. NAC comprised higher-risk disease (stage III 40% vs 10%) with more HER2-positive (25% vs 9%) and triple-negative tumours (20% vs 8%); AC patients were older and more comorbid (≥1 comorbidity 40% vs 30%). Mean RDI ranged 78%–92%. Neutropenia was most frequent (26 vs 24/100 cycles), and febrile neutropenia was higher with NAC (7 vs 5/100 cycles). Process adherence was high (pre-cycle labs 96%–97%, antiemetic concordance 93%–96%, G-CSF 88%–95%). Older age, stage III, and ≥1 comorbidity predicted both endpoints, whereas treatment setting was not independently associated. Chemotherapy delivery was largely guideline-concordant; modestly lower dose intensity and higher toxicity in the higher-risk neoadjuvant cohort underscore the value of supportive-care systems. https://biomedpharmajournal.org/vol19no3/relative-dose-intensity-toxicity-and-supportive-care-in-early-breast-cancer-neoadjuvant-versus-adjuvant-chemotherapy/ Antineoplastic Combined Chemotherapy Protocols Breast Neoplasms Dose Intensity Granulocyte Colony-Stimulating Factor Neoadjuvant Chemotherapy