Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.
Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Eng J Med 1993; 328: 1323-32
Cooksley T, Holland M. The febrile patient with neutropenia. Acute Med 2012; 11: 246-50.
Kuderer N, Dale D, Crawford J, Cosler L, Lyman G. Mortality, morbidity and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106: 2258-66.
Friefeld A, Bow E, Sepkowitz K et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011; 52: e56-e93.
Klastersky J, Paesmans M, Georgala A et al. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 2006; 24: 4129-34.
Talcott J, Yeap B, Clark J et al. Safety of early discharge for lowrisk patients with febrile neutropenia: a multicentre randomized controlled trial. J Clin Oncol 2011; 29: 3977-3988.
Paesmans M, Klastersky J, Maertens J et al. Predicting febrile neutropenic patients at low risk using the MASCC score: does bacteremia matter? Support Care Cancer 2011; 19: 1001-1008.
Lynn J, Chen K, Weng Y, Chiu T. Risk factors associated with complications in patients with chemotherapy-induced febrile neutropenia in emergency department. Hematol Oncol 2013; 31:189-96.
Klastersky J, Paesmans M, Rubenstein E et al. The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients. J Clin Onc 2000; 18: 3038-51.
Elting L, Lu C, Escalante C et al. Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. J Clin Onc 2008; 26: 606-11.
Klastersky J, Paesmans M. The Multinational Association for Supportive Care in Cancer (MASCC) risk score: 10 years of use for identifying low risk neutropenic cancer patients. Support Care Cancer 2013; 21: 1487-95.
Klastersky J, Paesmans M, Georgala A et al. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 2006; 24: 4129-34.
Uys A, Rapoport B, Anderson R. Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk index score. Support Care Cancer 2004; 12: 555-560.
Pun Hui E, Leung K, Poon T et al. Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network. Support Care Cancer 2011; 19: 1625-35.
Baskaran N, Gan G, Adeeba K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol 2008; 87: 563-9.
Cherif H, Johannsson E, Bjorkholm M et al. The feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica 2006; 91: 215-222.
NICE Guideline. Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients. September 2012.
Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J et al. 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 Onc 2015; 33: 465-71.
Carstensen M, Sorensen J. Outpatient management of febrile neutropenia: time to revise present treatment strategy. J Support Oncol 2008; 6: 199-208.
Teuffel O, Ethier M, Alibhal S et al. Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol 2011; 22: 2358-65.
Freifeld A, Marchigiani D, Walsh T et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer with chemotherapy. N Engl J Med 1999; 341: 305-11.
Kern W, Marchetti O, Drgona L et al. Oral antibiotics for fever in low-risk neutropenic patients with cancer: A double-blind, randomized, multicentre trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxicillin/clavulanic acid combination therapy – EORTC Infectious Diseases Group trial XV. J Clin Onc 2013; 31: 1149-56.
Lingaratnam S, Thursky K, Slavin M. Fluoroquinolone prophylaxis: a word of caution. Leuk Lymphoma 2011; 52: 5-6.
Teuffel O, Amir E, Alibhai S et al. Cost-effectiveness of outpatient treatment for febrile neutropenia in adult cancer patients. B J Cancer 2011; 104: 1377-83.
Innes H, Billingham L, Gaunt C et al. Management of febrile neutropenia in the United Kingdom: Time for a national trial? Br J Cancer 2005; 93: 1324-28.
Ziglam H, Gelly K, Olver W. A survey of the management of neutropenic fever in oncology units in the UK. Int J Antimicrob Agents 2007; 29: 430-33.
Teuffel O, Cheng S, Ethier M et al. Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients. Support Care Cancer 2012; 20:2755-64.
Freifeld A, Sepkowitz K. No Place Like Home? Outpatient management of patients with febrile neutropenia and low risk. J Clin Onc 2011; 29: 3952-4.
Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.
Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Eng J Med 1993; 328: 1323-32
Cooksley T, Holland M. The febrile patient with neutropenia. Acute Med 2012; 11: 246-50.
Kuderer N, Dale D, Crawford J, Cosler L, Lyman G. Mortality, morbidity and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106: 2258-66.
Friefeld A, Bow E, Sepkowitz K et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011; 52: e56-e93.
Klastersky J, Paesmans M, Georgala A et al. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 2006; 24: 4129-34.
Talcott J, Yeap B, Clark J et al. Safety of early discharge for lowrisk patients with febrile neutropenia: a multicentre randomized controlled trial. J Clin Oncol 2011; 29: 3977-3988.
Paesmans M, Klastersky J, Maertens J et al. Predicting febrile neutropenic patients at low risk using the MASCC score: does bacteremia matter? Support Care Cancer 2011; 19: 1001-1008.
Lynn J, Chen K, Weng Y, Chiu T. Risk factors associated with complications in patients with chemotherapy-induced febrile neutropenia in emergency department. Hematol Oncol 2013; 31:189-96.
Klastersky J, Paesmans M, Rubenstein E et al. The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients. J Clin Onc 2000; 18: 3038-51.
Elting L, Lu C, Escalante C et al. Outcomes and cost of outpatient or inpatient management of 712 patients with febrile neutropenia. J Clin Onc 2008; 26: 606-11.
Klastersky J, Paesmans M. The Multinational Association for Supportive Care in Cancer (MASCC) risk score: 10 years of use for identifying low risk neutropenic cancer patients. Support Care Cancer 2013; 21: 1487-95.
Klastersky J, Paesmans M, Georgala A et al. Outpatient oral antibiotics for febrile neutropenic cancer patients using a score predictive for complications. J Clin Oncol 2006; 24: 4129-34.
Uys A, Rapoport B, Anderson R. Febrile neutropenia: a prospective study to validate the Multinational Association of Supportive Care of Cancer (MASCC) risk index score. Support Care Cancer 2004; 12: 555-560.
Pun Hui E, Leung K, Poon T et al. Prediction of outcome in cancer patients with febrile neutropenia: a prospective validation of the Multinational Association for Supportive Care in Cancer risk index in a Chinese population and comparison with the Talcott model and artificial neural network. Support Care Cancer 2011; 19: 1625-35.
Baskaran N, Gan G, Adeeba K. Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol 2008; 87: 563-9.
Cherif H, Johannsson E, Bjorkholm M et al. The feasibility of early hospital discharge with oral antimicrobial therapy in low risk patients with febrile neutropenia following chemotherapy for hematologic malignancies. Haematologica 2006; 91: 215-222.
NICE Guideline. Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients. September 2012.
Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J et al. 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 Onc 2015; 33: 465-71.
Carstensen M, Sorensen J. Outpatient management of febrile neutropenia: time to revise present treatment strategy. J Support Oncol 2008; 6: 199-208.
Teuffel O, Ethier M, Alibhal S et al. Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol 2011; 22: 2358-65.
Freifeld A, Marchigiani D, Walsh T et al. A double-blind comparison of empirical oral and intravenous antibiotic therapy for low-risk febrile patients with neutropenia during cancer with chemotherapy. N Engl J Med 1999; 341: 305-11.
Kern W, Marchetti O, Drgona L et al. Oral antibiotics for fever in low-risk neutropenic patients with cancer: A double-blind, randomized, multicentre trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxicillin/clavulanic acid combination therapy – EORTC Infectious Diseases Group trial XV. J Clin Onc 2013; 31: 1149-56.
Lingaratnam S, Thursky K, Slavin M. Fluoroquinolone prophylaxis: a word of caution. Leuk Lymphoma 2011; 52: 5-6.
Teuffel O, Amir E, Alibhai S et al. Cost-effectiveness of outpatient treatment for febrile neutropenia in adult cancer patients. B J Cancer 2011; 104: 1377-83.
Innes H, Billingham L, Gaunt C et al. Management of febrile neutropenia in the United Kingdom: Time for a national trial? Br J Cancer 2005; 93: 1324-28.
Ziglam H, Gelly K, Olver W. A survey of the management of neutropenic fever in oncology units in the UK. Int J Antimicrob Agents 2007; 29: 430-33.
Teuffel O, Cheng S, Ethier M et al. Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients. Support Care Cancer 2012; 20:2755-64.
Freifeld A, Sepkowitz K. No Place Like Home? Outpatient management of patients with febrile neutropenia and low risk. J Clin Onc 2011; 29: 3952-4.
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Professor of Medical
Oncology University
of Brussels and Chief of
Medicine Service, Institut
Jules Bordet, Department of
Internal Medicine
Ambulatory Outpatient Management of patients with low risk febrile neutropaenia
Cite this article as:
Cooksley T, Holland M, Klastersky J. Ambulatory Outpatient Management of patients with low risk febrile neutropaenia. Acute Med. 2015;14(4):178-81. PMID: 26726789.
Ambulatory Outpatient Management of patients with low risk febrile neutropaenia
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