Safety and effectiveness of outpatient therapy in 596 low-risk patients with febrile neutropenia (FN)

Abstract

8116 Background: Outpatient (Outpt) therapy was a major innovation in treatment of FN, but rapid adoption of this strategy precluded adequately powered clinical trials comparing Outpt with inpatient (Inpt) therapy. Among clinically eligible low-risk patients, non-medical barriers such as lack of a caregiver, mandate treatment in the Inpt setting. We compared the outcomes of low-risk pts with FN treated as Outpts to their low-risk counterparts who were treated as Inpts for non-medical reasons. Pts & Method: We selected 1 episode of FN at random for each of 596 consecutive low-risk pts. 103 pts with no caregiver or telephone at home, a history of non-compliance or residence >30 min from the hospital were treated initially as Inpts; 493 pts were treated initially as Outpts. We collected 6 outcomes from medical records: response to the initial antibiotic (abx) regimen, ultimate response (both defined as resolution of all signs and symptoms of infection), medical complications requiring treatment, and days of hospitalization, fever, and abx therapy. The Inpts and Outpts were similar in performance status, comorbidities, bacteremias, and pneumonias. There was a non-significant trend toward more mucositis in Inpts and they were older than Outpts. Confounding factors were strongly associated with outcomes. Thus, we compared Outpts’ outcomes with Inpts’ using logistic or linear regression (as appropriate) to adjust for these factors. Result: All Inpts and Outpts ultimately responded to abx therapy. After adjustment, there were no significant differences between Inpts’ and Outpts’ responses to initial abxs or rates of complications (Table). 19% of Outpts required hospitalization. Outpts’ mean length of stay was significantly shorter than those treated initially as Inpts. Conclusion: We found no evidence that Outpt therapy of FN in low-risk pts compromises effectiveness or safety. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration American Cancer Society, Bayer, Merck