PURPOSE: International guidelines adopt risk stratification approach to manage patients with low-risk febrile neutropenia patients. We developed this out-patient program using shared-care model with professional input and patient empowerment, so as to reduce patients' psychological burden from hospitalization and to improve the cost-effectiveness of management. METHOD: This is a prospective cohort study to compare the efficacy and safeness of the out-patient program when compared with traditional in-patient care. Patients with solid tumors, developed febrile neutropenia with Multinational Association of Supportive Care in Cancer score of at least 21, and good performance status were included. After initial assessment and the first dose of oral antibiotics, patients were observed in the ambulatory center. Stable patients were discharged home after 4 h of observation and nurse counseling. Patients' condition and clinical progress were regularly reviewed by specialist nurses within the following week by telephone and nurse clinic follow-up. The primary objective of the study is success rate, which defined as the resolution of fever and infection, without hospitalization or any change in antibiotics. RESULTS: From September 2014 to December 2016, a total of 38 patients were enrolled. Majority were female with breast cancer (97%). Two patients required hospitalization due to persistent fever. The success rate of the out-patient program was not significantly different from the historical in-patient cohort (94.9 versus 97.4%, p = 0.053). No mortality was observed. Patients' compliance to the program was 100%, to telephone follow-up, nurse clinic visits, and daily temperature record. CONCLUSION: Out-patient management of patients with low-risk febrile neutropenia is effective and safe through implementation of a structured protocol with joint inputs and engagement from clinicians, oncology nurses, and patients.
PURPOSE: International guidelines adopt risk stratification approach to manage patients with low-risk febrile neutropeniapatients. We developed this out-patient program using shared-care model with professional input and patient empowerment, so as to reduce patients' psychological burden from hospitalization and to improve the cost-effectiveness of management. METHOD: This is a prospective cohort study to compare the efficacy and safeness of the out-patient program when compared with traditional in-patient care. Patients with solid tumors, developed febrile neutropenia with Multinational Association of Supportive Care in Cancer score of at least 21, and good performance status were included. After initial assessment and the first dose of oral antibiotics, patients were observed in the ambulatory center. Stable patients were discharged home after 4 h of observation and nurse counseling. Patients' condition and clinical progress were regularly reviewed by specialist nurses within the following week by telephone and nurse clinic follow-up. The primary objective of the study is success rate, which defined as the resolution of fever and infection, without hospitalization or any change in antibiotics. RESULTS: From September 2014 to December 2016, a total of 38 patients were enrolled. Majority were female with breast cancer (97%). Two patients required hospitalization due to persistent fever. The success rate of the out-patient program was not significantly different from the historical in-patient cohort (94.9 versus 97.4%, p = 0.053). No mortality was observed. Patients' compliance to the program was 100%, to telephone follow-up, nurse clinic visits, and daily temperature record. CONCLUSION: Out-patient management of patients with low-risk febrile neutropenia is effective and safe through implementation of a structured protocol with joint inputs and engagement from clinicians, oncology nurses, and patients.
Authors: Alison G Freifeld; Eric J Bow; Kent A Sepkowitz; Michael J Boeckh; James I Ito; Craig A Mullen; Issam I Raad; Kenneth V Rolston; Jo-Anne H Young; John R Wingard Journal: Clin Infect Dis Date: 2011-02-15 Impact factor: 9.079
Authors: J Klastersky; M Paesmans; E B Rubenstein; M Boyer; L Elting; R Feld; J Gallagher; J Herrstedt; B Rapoport; K Rolston; J Talcott Journal: J Clin Oncol Date: 2000-08 Impact factor: 44.544
Authors: Catherine Sebban; Sophie Dussart; Christine Fuhrmann; Hervé Ghesquieres; Isabelle Rodrigues; Lionel Geoffrois; Yves Devaux; Laurence Lancry; Giselle Chvetzoff; Thomas Bachelot; Maria Chelghoum; Pierre Biron Journal: Support Care Cancer Date: 2008-01-15 Impact factor: 3.603
Authors: David F Gaieski; Mark E Mikkelsen; Roger A Band; Jesse M Pines; Richard Massone; Frances F Furia; Frances S Shofer; Munish Goyal Journal: Crit Care Med Date: 2010-04 Impact factor: 7.598