A Study to Assess the Management of Febrile Neutropenia in Oncology Patients in a Tertiary Care Hospital

Abstract

Background: The cytotoxic chemotherapy is the mainstay treatment of cancer and it is usually complicated with infections. Appropriate antibiotics and other supportive medications must be started immediately as bacterial infections may progress with the absence of granulocytes. Improved outcomes can be seen with empirical administration of broad-spectrum antibiotics and they remain as the standard of care. Patients with intermediate-risk for Febrile Nuetropenia (FN) (10%-20%) need to be evaluated for additional patient risk factors, after assessment, patients who present with at least one of the risk factors for FN is recommended for treatment with a G-CSF. Methodology: Our study was a retrospective cohort single centered observational study carried out randomly in 104 patients in the oncology department of Lourdes hospital, Cochin Data of the patients were collected from Mediware system, medical records and Statistical software SPSS were used for analysis of the data. Results: In our study febrile neutropenia was managed using antimicrobials, of which antibiotics and antifungals prescribed were 12.09% and 1.97% respectively and with granulocyte-colony stimulating factors (G-CSFs) (6.15%). Principally used empirical monotherapy was meropenem sulbactum / meropenem (n = 48) which was followed by piperacillin tazobactum (n=18) and cefoperazone sulbactum (n=15) This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The compliance with National Comprehensive Cancer Network (NCCN) guidelines were analyzed in that we can see 84.6% patients had partial compliance and 14.4% patients had full compliance. Conclusion: A total of 66 patients received both antibiotics and G-CSF treatment however 13 patients and 25 patients were managed only with G-CSF and antibiotic therapy respectively. This study had a leading prescription of Cyclophosphamide containing chemotherapy regimens which led to neutropenia. These regimens were used mainly in breast cancer patients. Breast cancer patients accounts the majority of febrile neutropenic episodes despite of receiving GCSF prophylaxis. The most common type of cancer patients who are suffering from neutropenia were breast cancer. The NCCN guidelines, majority of patients showed partial compliance(86.6%) and about (14.4%) showed full compliance.