Low-risk patients with fever and neutropenia during chemotherapy: Current clinical practice patterns

Abstract

8089 Background: Fever during neutropenia is a common complication of cytotoxic chemotherapy. There is increasing evidence that oral antibiotics, outpatient treatment, or both may be appropriate for a select group of low-risk febrile neutropenic (F&N) patients. The objective of this study is to describe the role of oral and/or outpatient therapies in clinical practice patterns of physicians treating cancer patients. Methods: A national survey of 3600 randomly selected oncologists and hematologists (ASCO members) in the U.S. was used to determine current clinical practice patterns for low-risk F&N patients. Questions included therapy choices and 4 case scenarios designed to assess factors associated with physicians' willingness to use outpatient antibiotics. Probability of willingness to use outpatient antibiotics was modeled as a function of 8 key criteria: tumor type, presenting ANC, expected neutropenia duration, comorbidities, age, renal and hepatic function, pulmonary status, and distance from the hospital. Results: Completed surveys were received from 34% of actively practicing physicians: 69% private practice, 27% academic, 3% managed care; 16 yrs (mean) in practice. 82% of respondents use outpatient antibiotics for selected low risk F&N patients - 28% of them indicated use of such treatment in ≥ 65% of their patients . For respondents indicating outpatient treatment for ≥ 5% of their F&N patients, factors predicting for outpatient antibiotic therapy were disease (breast cancer vs. leukemia/non-Hodgkin = s lymphoma), serious infection (catheter, prior invasive fungal, prior resistant bacterial vs. other) and x-ray evidence of infiltrate (present vs. absent). When outpatient monotherapy is used, oral levofloxacin is most commonly prescribed (50%), followed by ciprofloxacin alone (36%), and ciprofloxacin + amoxicillin/clavulanate (35%). 4% of physicians routinely add vancomycin to empiric regimens, 48% add G- or GM-CSF to treatment. Fluoroquinolone prophylaxis for low-risk patients is used by 45%. Conclusions: Physicians are willing to accept outpatient treatment for low-risk F&N patients, although treatment algorithms vary. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Ortho-McNeil