Abstract
Although the clinical practice guideline for outpatient management of febrile neutropenia (FN) in adults treated for malignancy was updated by the ASCO/IDSA in 2018, most patients with FN in our hospital have been hospitalized. We performed this study to analyze the usefulness of the guideline. The medical records of patients hospitalized for FN in Kyungpook National University Chilgok Hospital from May 2016 to April 2018 were retrospectively reviewed. The feasibility of candidates for outpatient management according to the guideline was evaluated based on the outcomes. A total of 114 patients were enrolled and categorized into two groups, low-risk (38.6%) and high-risk (61.4%). The proportion of feasible candidates for outpatient management was 70.2% and was higher in the low-risk than in the high-risk group (90.0% vs. 57.1%; P < 0.001). The low-risk group had no mortality, no resistance to oral amoxicillin/clavulanate or ciprofloxacin, a higher rate of successful empirical antibiotics, and lower rates of glycopeptide or carbapenem administration. A significant number of hospitalized cancer patients treated for FN after chemotherapy were found to be feasible candidates for outpatient management. The guideline can be a useful tool to reduce labor of healthcare workers and hospitalization costs.
Highlights
In 2018, the American Society of Clinical Oncology (ASCO) and the Infectious Diseases Society of America (IDSA) updated the clinical practice guideline for outpatient management of febrile neutropenia (FN)[1]
It may be difficult for the 2018 ASCO/IDSA guideline to be applied directly in our cancer center because of different circumstances in each country and region
The patients in the low-risk group (LRG) were admitted more often as outpatients (47.7% vs. 19.2%; P = 0.001), experienced unexplained fever more frequently (90.9% vs. 62.9%; P = 0.002), and had shorter durations of fever (1.5 vs. 2.3; P = 0.014), neutropenia (2.4 vs. 3.1 d; P = 0.014), and hospitalization after an FN episode (5.0 vs. 12.4 d; P < 0.001) than those in the high-risk group (HRG)
Summary
In 2018, the American Society of Clinical Oncology (ASCO) and the Infectious Diseases Society of America (IDSA) updated the clinical practice guideline for outpatient management of febrile neutropenia (FN)[1]. Considering patient safety, overcrowded ERs, and the burden on healthcare workers and finances, patients who are suitable for outpatient management should be treated on an outpatient basis rather than hospitalized. It may be difficult for the 2018 ASCO/IDSA guideline to be applied directly in our cancer center because of different circumstances in each country and region. We conducted this study to determine the proportion of hospitalized patients who could be treated in an outpatient setting if the 2018 ASCO/IDSA guideline were implemented. We analyzed the feasibility of candidates for outpatient management according to the guideline by assessing the treatment outcomes of the patients
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