A novel approach to improving ambulatory outpatient management of low risk febrile neutropenia: an Enhanced Supportive Care (ESC) clinic

Cooksley, Tim; Campbell, Geraldine; Al-Sayed, Tamer; LaMola, Lisa; Berman, Richard

doi:10.1007/s00520-018-4194-1

Cited by 22 publications

(20 citation statements)

References 15 publications

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“…However, a large proportion of patients with cancer experience debilitating morbidity and complex symptoms, resulting from cancer and/or its treatment across the entire cancer journey. Supportive care has been shown to improve quality of life, symptom burden and survival, as well as benefitting the health economy [ [15] , [16] , [17] ]. Thus, supportive care should be an integral component of modern oncology management and should involve input from a range of specialties within and outside of oncology.…”

Section: Discussionmentioning

confidence: 99%

“…This facilitates improved access for patients to expertise in cancer care and immediate management of the complications of cancer treatment, with the goal of preventing downstream complications and future emergency presentations. For example, ambulatory enhanced supportive care models have shown utility in the management of low-risk febrile neutropenia [ 17 ].…”

Section: Interface With Acute Oncology – Ambulatory Supportive Carementioning

confidence: 99%

“…There is a growing body of evidence that timely access to supportive treatments can lead to improvements in quality of life and survival, as well as benefitting the health economy [ [15] , [16] , [17] ]. The development of a broad multiprofessional basis for the study and expansion of supportive care through the Multinational Association of Supportive Care in Cancer (MASCC) has been an important step in fostering the growth of an evidence base [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as ‘the prevention and management of the adverse effects of cancer and its treatment’. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.

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Section: Discussionmentioning

confidence: 99%

Section: Interface With Acute Oncology – Ambulatory Supportive Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Supportive Care: An Indispensable Component of Modern Oncology

et al. 2020

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“…The benefits of emergency outpatient care include admission avoidance, reducing pressure on often overcrowded and overstretched emergency departments, cost savings, reduced risk of nosocomial infections, and improved patient experience and satisfaction [36][37][38]. Adherence to these measures is particularly important during the COVID-19 pandemic.…”

Section: Outpatient Management Of Febrile Neutropeniamentioning

confidence: 99%

“…These models offer the opportunity to integrate palliative and supportive care with oncology and acute services. This may facilitate improved access of patients to expertise in cancer care, as well as immediate management of the complications of cancer treatment with the goal of preventing downstream complications and future emergency presentations [38,60]. Moreover, the health crisis that has arisen from the COVID-19 pandemic may engender rethinking of, and enhance ethical approaches in, the care of cancer patients [61], as well as improved communication and education of patients that will lead to tailoring of value-based shared decisionmaking strategies in the era of precision medicine.…”

Section: Expanded Use Of Granulocyte Colony-stimulating Factor Duringmentioning

confidence: 99%

Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper

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et al. 2020

Support Care Cancer

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Patients with cancer are at higher risk of more severe COVID-19 infection and have more associated complications. The position paper describes the management of cancer patients, especially those receiving anticancer treatment, during the COVID-19 pandemic. Dyspnea is a common emergency presentation in patients with cancer with a wide range of differential diagnoses, including pulmonary embolism, pleural disease, lymphangitis, and infection, of which SARS-CoV-2 is now a pathogen to be considered. Screening interviews to determine whether patients may be infected with COVID-19 are imperative to prevent the spread of infection, especially within healthcare facilities. Cancer patients testing positive with no or minimal symptoms may be monitored from home. Telemedicine is an option to aid in following patients without potential exposure. Management of complications of systemic anticancer treatment, such as febrile neutropenia (FN), is of particular importance during the COVID-19 pandemic where clinicians aim to minimize patients' risk of infection and need for hospital visits. Outpatient management of patients with low-risk FN is a safe and effective strategy. Although the MASCC score has not been validated in patients with suspected or confirmed SARS-CoV-2, it has nevertheless performed well in patients with a range of infective illnesses and, accordingly, it is reasonable to expect efficacy in the clinical setting of COVID-19. Risk stratification of patients presenting with FN is a vital tenet of the evolving sepsis and pandemic strategy, necessitating access to locally formulated services based on MASCC and other national and international guidelines. Innovative oncology services will need to utilize telemedicine, hospital at home, and ambulatory care services approaches not only to limit the number of hospital visits but also to anticipate the complications of the anticancer treatments.

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Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

et al. 2023

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ImportanceAn initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented.ObjectiveTo explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US.Design, Setting, and ParticipantsThis cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated.Main Outcomes and MeasuresThe primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare &amp; Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization.ResultsAmong 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization.Conclusions and RelevanceIn this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

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A novel approach to improving ambulatory outpatient management of low risk febrile neutropenia: an Enhanced Supportive Care (ESC) clinic

Abstract: The ESC clinic maybe an effective method for delivering outpatient ambulatory management of patients with LRFN.

Cited by 22 publications

References 15 publications

Supportive Care: An Indispensable Component of Modern Oncology

Supportive Care: An Indispensable Component of Modern Oncology

Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper

Trends and Characteristics of Potentially Preventable Emergency Department Visits Among Patients With Cancer in the US

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