Outpatient treatment for people with cancer who develop a low-risk febrile neutropaenic event

Abstract

Outpatient treatment for people with cancer who develop a low-risk febrile neutropaenic event.

Is Outpatient Treatment for Low-Risk Febrile Neutropenic Cancer Patients Associated With Increased Treatment Failure or Mortality?

“…Fever in the setting of neutropenia, defined as an absolute neutrophil count of less than 500/ mm 3 or projected to soon nadir below that threshold, is a major complication for patients with malignancy and those receiving chemotherapy. 2 Affecting 10% to 50% of patients with solid tumors and greater than 80% of those with hematologic malignancies, neutropenic fever is a frequent emergency department (ED) chief complaint. 3 Admission for these immunocompromised patients is not without serious risk of hospital-acquired infections, highlighting the need to weigh the risks and benefits of early discharge and outpatient management for low-risk patients.…”

“…Authors found that early discharge or complete outpatient management of identified low-risk patients did not increase mortality or treatment failure. 2 However, a major consideration is to ensure that the patient with neutropenic fever is truly at low risk. Various tools are available for risk stratification in adult patients with neutropenic fever, including the Clinical Index of Stable Febrile Neutropenia score, the Multinational Association for Supportive Care in Cancer risk index, and Infectious Diseases Society of America Risk Criteria.…”

Outpatient Treatment for Low‐Risk Febrile Neutropenia

“…This systematic review and meta‐analysis included randomized controlled trials that compared inpatient antimicrobial therapy with outpatient antimicrobial therapy for low‐risk febrile neutropenic adults or children with cancer. The primary outcomes were treatment failure (death, nonresolution of signs or symptoms of presenting infection, or change of antibiotic) and mortality at 30 days.…”

“…Additionally, low‐risk criteria varied between studies with only one utilizing Multinational Association for Supportive Care in Cancer criteria and none using Clinical Index of Stable Febrile Neutropenia criteria, the two currently recommended tools . There are no existing criteria for low‐risk stratification in pediatric patients with neutropenic fever.…”

Recent advances in the prevention and management of infections in children undergoing treatment for cancer

“…When they have, they have shown only moderate value and require refinement 16, 17 . Practically, implementing a method of risk stratifying and treating using such a rule has been shown to be relatively safe, both across all ages 18 and specifically in children 19 . The approaches tend to use a combination of factors related to the malignant diagnosis of the child, their social situation, and episode-related elements.…”