Self-assessment system of febrile neutropenia (FN) by patients receiving ambulatory chemotherapy for solid tumor.

Abstract

e19548 Background: Febrile neutropenia is one of the oncology emergencies, which usually should be timely assessed and treated at the hospital. In some areas of Japan, however, medical resources are limited in especially nights and holidays. In Hyogo Cancer Center department of medical oncology, majority of pts have breast and gynecologic (GYN) malignant disease, those who are relatively young and without COPD. These pts may be managed by a self -assessment system of FN, although the feasibility is still unknown. Methods: Self assessment system consists of three steps, such as, prescription of Ciprofloxacin 1200mg b.i.d., educating pts by the team (doctors, pharmacists, and nurses) with written material, and evaluation at the hospital if febrile episode (FE) continues for longer than 48 hours. FE is defined as body temperature higher than 38 °C. Frequency of FE, admission to the hospital, ICU stay, and 30 days mortality rate were assessed retrospectively. Results: From Aug. 2006 to Oct. 2011, 476 pts were treated in ambulatory chemotherapy center under self-assessment system. Median age was 58 years old (range; 17 - 82), 87 % of them were under 60 years old. Literacy rate was 100 %. All had solid tumors, 75 % of them had breast (n= 157) or GYN (ovary and primary peritoneal cancer; n = 155, cervix; n = 40, corpus; n = 4) malignancy. Platinum based regimens (n = 184) and anthracycline based regimens (n = 131) were dominant. FE occurred in 159 pts (33.4%). Forty three pts (9%) were admitted to the hospital. Two pts were admitted to ICU. 30 days mortality rate was 0 %. The median MASCC score of admitted pts was 21 (range; 14 - 21). About half (47 %) had high risk score (< 20). Conclusions: In areas with limited resources, self assessment of FN can be an alternative option, although that should be applied to young and literate pts educated by skilled medical team.