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Supportive Care in Cancer

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Open Access 01-11-2023 | Review

Ambulatory management of low-risk febrile neutropenia in adult oncological patients. Systematic review

Authors: Ester Forcano-Queralt, Cristina Lemes-Quintana, Domingo Orozco-Beltrán

Published in: Supportive Care in Cancer | Issue 11/2023

Abstract

Purpose

Recent clinical practice guidelines have recommended ambulatory management of febrile neutropenia in patients with low risk of complications. Although some centers have begun developing management protocols for these patients, there appears to be a certain reluctance to implement them in clinical practice. Our aim is to evaluate the strengths and weaknesses of this strategy according to available evidence and to propose new lines of research.

Methods

Systematic review using a triple aim approach (efficacy, cost-effectiveness, and quality of life), drawing from literature in MEDLINE (PubMed), Embase, and Cochrane Library databases. The review includes studies that assess ambulatory management for efficacy, cost-efficiency, and quality of life.

Results

The search yielded 27 articles that met our inclusion criteria.

Conclusion

In conclusion, based on current evidence, ambulatory management of febrile neutropenia is safe, more cost-effective than inpatient care, and capable of improving quality of life in oncological patients with this complication. Ambulatory care seems to be an effective alternative to hospitalization in these patients.

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Chisholm J, Dommett R (2006) The evolution towards ambulatory and day-case management of febrile neutropenia. Br J Haematol 135(1):3–16CrossRefPubMed

Kern W, Marchetti O, Drgona L, Akan H, Aoun M, Akova M, de Bock R, Paesmans M, Viscoli C, Calandra T (2013) Oral antibiotics for fever in low-risk neutropenic patients with cancer: a double-blind, randomized, multicenter trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxicillin/clavulanic acid combination therapy—EORTC infectious diseases group trial XV. J Clin Oncol 31(9):1149–1156CrossRefPubMed

Talcott J, Yeap B, Clark J, Siegel R, Loggers E, Lu C, Godley P (2011) Safety of early discharge for low-risk patients with febrile neutropenia: a multicenter randomized controlled trial. J Clin Oncol 29(30):3977–3983CrossRefPubMedPubMedCentral

Sebban C, Dussart S, Fuhrmann C, Ghesquieres H, Rodrigues I, Geoffrois L, Devaux Y, Lancry L, Chvetzoff G, Bachelot T, Chelghoum M, Biron P (2008) Oral moxifloxacin or intravenous ceftriaxone for the treatment of low-risk neutropenic fever in cancer patients suitable for early hospital discharge. Support Care Cancer 16(9):1017–1023. https://doi.org/10.1007/s00520-007-0383-zCrossRefPubMed

Innes HE, Smith DB, O’Reilly SM, Clark PI, Kelly V, Marshall E (2003) Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study. Br J Cancer 89(1):43–49. https://doi.org/10.1038/sj.bjc.6600993CrossRefPubMedPubMedCentral

Hidalgo M, Hornedo J, Lumbreras C, Trigo JM, Colomer R, Perea S, Gómez C, Ruiz A, García-Carbonero R, Cortés-Funes H (1999) Outpatient therapy with oral ofloxacin for patients with low risk neutropenia and fever: a prospective, randomized clinical trial. Cancer. 85(1):213–219CrossRefPubMed

Minotti V, Gentile G, Bucaneve G, Iori AP, Micozzi A, Cavicchi F, Barbabietola G, Landonio G, Menichetti F, Martino P, Del Favero A (1999) Domiciliary treatment of febrile episodes in cancer patients: a prospective randomized trial comparing oral versus parenteral empirical antibiotic treatment. Support Care Cancer 7(3):134–139. https://doi.org/10.1007/s005200050243CrossRefPubMed

Rapoport BL, Sussmann O, Herrera MV, Schlaeffer F, Otero JC, Pavlovsky S, Iglesias L, Stein G, Charnas R, Heitlinger E, Handschin J (1999) Ceftriaxone plus once daily aminoglycoside with filgrastim for treatment of febrile neutropenia: early hospital discharge vs. standard in-patient care. Chemotherapy. 45(6):466–476. https://doi.org/10.1159/000007240CrossRefPubMed

Malik IA, Khan WA, Karim M, Aziz Z, Khan MA (1995) Feasibility of outpatient management of fever in cancer patients with low-risk neutropenia: results of a prospective randomized trial. Am J Med 98(3):224–231. https://doi.org/10.1016/s0002-9343(99)80367-2CrossRefPubMed

10.

Rubenstein EB, Rolston K, Benjamin RS, Loewy J, Escalante C, Manzullo E, Hughes P, Moreland B, Fender A, Kennedy K et al (1993) Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer. 71(11):3640–3646. https://doi.org/10.1002/1097-0142(19930601)71:11<3640::aid-cncr2820711128>3.0.co;2-hCrossRefPubMed

11.

Taplitz R, Kennedy E, Bow E, Crews J, Gleason C, Hawley D, Langston A, Nastoupil L, Rajotte M, Rolston K, Strasfeld L, Flowers C (2018) Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update. J Clin Oncol 36(14):1443–1453CrossRefPubMed

12.

Carmona-Bayonas A, Jimenez-Fonseca P, de Castro E, Mata E, Biosca M, Custodio A, Espinosa J, Vázquez E, Henao F, Ayala de la Peña F (2019) SEOM clinical practice guideline: management and prevention of febrile neutropenia in adults with solid tumors (2018). Clin Transl Oncol 21(1):75–86CrossRefPubMed

13.

Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Feld R, Gallagher J, Herrstedt J, Rapoport B, Rolston K, Talcott J (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol 18(16):3038–3051. https://doi.org/10.1200/JCO.2000.18.16.3038CrossRefPubMed

14.

Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M et al (2015) Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol 33(5):465–471CrossRefPubMed

15.

Mizuno T, Katsumata N, Mukai H, Shimizu C, Ando M, Watanabe T (2007) The outpatient management of low-risk febrile patients with neutropenia: risk assessment over the telephone. Support Care Cancer 15(3):287–291 Epub 2006 Aug 29CrossRefPubMed

16.

Rolston K, Manzullo E, Elting L, Frisbee-Hume S, McMahon L, Theriault R, Patel S, Benjamin R (2006) Once daily, oral, outpatient quinolone monotherapy for low-risk cancer patients with fever and neutropenia: a pilot study of 40 patients based on validated risk-prediction rules. Cancer. 106(11):2489–2494CrossRefPubMed

17.

Lingaratnam S, Mellerick A, Worth L, Green M, Guy S, Kirsa S, Slavin M, Renwick W, Filshie R, Thursky K (2013) Feasibility of early discharge strategies for neutropenic fever: outcomes of a Victorian organisational readiness assessment and pilot. Intern Med J 43(9):979–986CrossRefPubMed

18.

Rolston K, Frisbee-Hume S, Patel S, Manzullo E, Benjamin R (2010) Oral moxifloxacin for outpatient treatment of low-risk, febrile neutropenic patients. Support Care Cancer 18(1):89–94CrossRefPubMed

19.

Hocking C, Taylor A, Hayward A (2013) Early discharge and ambulatory care of low-risk patients with neutropenic fever in Australia. Intern Med J 43(5):591–595CrossRefPubMed

20.

Poprawski D, Chan J, Barnes A, Koczwara B (2018) Retrospective audit of neutropenic fever after chemotherapy: how many patients could benefit from oral antibiotic management? Intern Med J 48(12):1533–1535CrossRefPubMed

21.

Weycker D, Barron R, Kartashov A, Legg J, Lyman G (2014) Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings. J Oncol Pharm Pract 20(3):190–198CrossRefPubMed

22.

Goodman L, Estfan B, Montero A, Kunapareddy G, Lau J, Gallagher E, Best C, Tripp B, Moeller M, Bolwell B, Stevenson J (2017) Improving the management of patients with low-risk neutropenic fever at the Cleveland Clinic Taussig Cancer Institute. J Oncol Pract 13(3):e259–e265CrossRefPubMed

23.

Cooksley T, Campbell G, Al-Sayed T, La Mola L, Berman R (2018) A novel approach to improving ambulatory outpatient management of low risk febrile neutropenia: an Enhanced Supportive Care (ESC) clinic. Support Care Cancer 26(9):2937–2940CrossRefPubMed

24.

Kuderer N, Dale D, Crawford J, Cosler L, Lyman G (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer. 106(10):2258–2266CrossRefPubMed

25.

Mayordomo J, López A, Viñolas N, Castellanos J, Pernas S, Domingo Alonso J, Frau A, Layola M, Antonio Gasquet J, Sánchez J; ENIA Study Group (2009) Retrospective cost analysis of management of febrile neutropenia in cancer patients in Spain. Curr Med Res Opin 25(10):2533–2542CrossRef

26.

O’Brien C, Fogarty E, Walsh C, Dempsey O, Barry M, Kennedy M, McCullagh L (2015) The cost of the inpatient management of febrile neutropenia in cancer patients—a micro-costing study in the Irish healthcare setting. Eur J Cancer Care (Engl) 24(1):125–132CrossRefPubMed

27.

Elting L, Rubenstein E, Rolston K, Cantor S, Martin C, Kurtin D, Rodriguez S, Lam T, Kanesan K, Bodey G (2000) Time to clinical response: an outcome of antibiotic therapy of febrile neutropenia with implications for quality and cost of care. J Clin Oncol 18(21):3699–3706CrossRefPubMed

28.

Elting L, Lu C, Escalante C, Giordano S, Trent J, Cooksley C, Avritscher E, Shih Y, Ensor J, Bekele B, Gralla R, Talcott J, Rolston K (2008) Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. J Clin Oncol 26(4):606–611CrossRefPubMed

29.

Hendricks A, Loggers E, Talcott J (2011) Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial. J Clin Oncol 29(30):3984–3989CrossRefPubMedPubMedCentral

30.

Teh B, Brown C, Joyce T, Worth L, Slavin M, Thursky K (2018) Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre. Support Care Cancer 26(3):997–1003CrossRefPubMed

31.

Borget I, Antoun S, Chachaty E, Gachot B, Alibay A, Di Palma M, Merad M (2014) Modalities of management of cancer patients with febrile neutropenia in the oncology emergency unit of Gustave-Roussy and their related costs. Bull Cancer 101(10):925–931CrossRefPubMed

32.

Teuffel O, Cheng S, Ethier M, Diorio C, Martino J, Mayo C, Wing R, Sung L, Alibhai S (2012) Health-related with different management strategies for febrile neutropenia in adult cancer patients. Support Care Cancer 20(11):2755–2764CrossRefPubMed

33.

Ahn S, Rice T, Yeung S, Cooksley T (2018) Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Support Care Cancer 26(5):1465–1470PubMed

34.

Ahn S, Lee Y, Lim K, Lee J (2013) Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia. Support Care Cancer 21(8):2303–2308CrossRefPubMed

35.

Mather D, Lieschke G, Green M (1994) Filgastrim in patients with chemotherapy-induced febrile neutropenia. Ann Intern Med 121:492–501CrossRef

36.

Klastersky J, Paesmans M, Georgala A, Muanza F, Plehiers B, Dubreucq L et al (2006) Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 24(25):4129–4134. Disponible en:. https://doi.org/10.1200/JCO.2005.03.9909CrossRefPubMed

37.

Teuffel O, Ethier M, Alibhai S, Beyene J, Sung L (2011) Cost effectiveness of outpatient treatment for febrile neutropaenia in adult cancer patients. Br J Cancer 104(9):1377–1383CrossRefPubMedPubMedCentral

Title: Ambulatory management of low-risk febrile neutropenia in adult oncological patients. Systematic review
Authors: Ester Forcano-Queralt
Cristina Lemes-Quintana
Domingo Orozco-Beltrán
Publication date: 01-11-2023
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 11/2023
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-023-08065-y

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Abstract

Purpose

Methods

Results

Conclusion

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