Usefulness analysis of the 2018 ASCO/IDSA guideline for outpatient management of fever and neutropenia in adults treated for malignancy

Sci Rep. 2021 Sep 15;11(1):9048. doi: 10.1038/s41598-021-88207-6.

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.

MeSH terms

  • Aged
  • Ambulatory Care* / methods
  • Ambulatory Care* / statistics & numerical data
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biomarkers
  • Clinical Decision-Making
  • Disease Management
  • Febrile Neutropenia / diagnosis
  • Febrile Neutropenia / epidemiology
  • Febrile Neutropenia / etiology
  • Febrile Neutropenia / therapy
  • Female
  • Fever / epidemiology*
  • Fever / etiology*
  • Humans
  • Leukocyte Count
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Neoplasms / therapy
  • Neutropenia / diagnosis
  • Neutropenia / epidemiology*
  • Neutropenia / etiology*
  • Neutropenia / therapy
  • Practice Guidelines as Topic
  • Retrospective Studies

Substances

  • Biomarkers