BACKGROUND: In some centers, outpatient management for cancer patients with low-risk febrile neutropenia (FN) has been implemented into routine clinical practice. Our objective was to evaluate the current level of evidence before supporting widespread adoption of outpatient management for this population. METHODS: We systematically reviewed randomized controlled trials evaluating efficacy and safety of outpatient management of FN. RESULTS: From 1448 reviewed articles, 14 studies were included for meta-analysis. (i) Inpatient versus outpatient setting (6 studies) was not significantly associated with treatment failure [risk ratio 0.81; 95% confidence interval (CI) 0.55-1.19; P = 0.28]. Death occurred in 13 of 742 FN episodes with no difference between the two groups (risk ratio 1.11; 95% CI 0.41-3.05; P = 0.83). (ii) Outpatient oral versus outpatient parenteral antibiotics (8 studies) were similarly efficacious with no association between route of drug administration and treatment failure (risk ratio 0.93; 95% CI 0.65-1.32; P = 0.67). No death occurred in 857 FN episodes. CONCLUSION: Based on the current literature, outpatient treatment of FN is a safe and efficacious alternative to inpatient management. Variation between studies in terms of time to discharge, choice of antibiotic class, and age of study population may limit the interpretation of the data.
BACKGROUND: In some centers, outpatient management for cancerpatients with low-risk febrile neutropenia (FN) has been implemented into routine clinical practice. Our objective was to evaluate the current level of evidence before supporting widespread adoption of outpatient management for this population. METHODS: We systematically reviewed randomized controlled trials evaluating efficacy and safety of outpatient management of FN. RESULTS: From 1448 reviewed articles, 14 studies were included for meta-analysis. (i) Inpatient versus outpatient setting (6 studies) was not significantly associated with treatment failure [risk ratio 0.81; 95% confidence interval (CI) 0.55-1.19; P = 0.28]. Death occurred in 13 of 742 FN episodes with no difference between the two groups (risk ratio 1.11; 95% CI 0.41-3.05; P = 0.83). (ii) Outpatient oral versus outpatient parenteral antibiotics (8 studies) were similarly efficacious with no association between route of drug administration and treatment failure (risk ratio 0.93; 95% CI 0.65-1.32; P = 0.67). No death occurred in 857 FN episodes. CONCLUSION: Based on the current literature, outpatient treatment of FN is a safe and efficacious alternative to inpatient management. Variation between studies in terms of time to discharge, choice of antibiotic class, and age of study population may limit the interpretation of the data.
Authors: Tim Cooksley; Geraldine Campbell; Tamer Al-Sayed; Lisa LaMola; Richard Berman Journal: Support Care Cancer Date: 2018-04-19 Impact factor: 3.603
Authors: Fiona Lim Mei Ying; Maria Choy Yin Ping; Macy Tong; Elaine Yim Pik Yan; Tracy Lui Siu Yee; Lam Yuk Ting; Anita Lo Wing Sim; Lui Cheuk Yu; Bosco Lam Hoi Shiu; Ashley Cheng Chi Kin Journal: Support Care Cancer Date: 2018-03-20 Impact factor: 3.603