Managing Patients With Low-Risk Neutropenic Fever at Cleveland Clinic Taussig Cancer Institute
In a study reported in the Journal of Oncology Practice, Goodman et al described a management practice for low-risk neutropenic fever in cancer patients that has reduced in-patient stay with intravenous antibiotic use at Cleveland Clinic Taussig Cancer Institute.
Study Details
In the study, inpatient provider algorithm implementation and education were initiated in the second quarter of 2014. Multinational Association for Supportive Care in Cancer (MASCC) scores for patients with nonleukemia hematologic malignancies and solid tumors were calculated at admission. Patients identified as low risk by MASCC score were observed and started on oral antibiotics. If no exclusion criteria or social barriers prevented discharge, discharge was planned to occur within 48 hours.
Outcomes
A total of 83 patients with neutropenic fever were admitted to the inpatient oncology unit between November 2014 and June 2015. Of them, 53 patients (64%) had low-risk status on MASCC scoring and received modified management. The average length of stay among patients with low-risk status was 3.3 days, compared with 6.2 days in an institutional historical cohort, with 16 low-risk patients (30%) being discharged within 24 hours. Culture-proven infection was found in two patients (4%) with low-risk neutropenic fever, both with Enterococcus urinary tract infection. Three patients (6%) required nonelective readmission. No deaths were caused by neutropenic fever.
The investigators concluded: “This pilot study demonstrates that a formal algorithm for [low-risk neutropenic fever] management combined with provider education can improve current inpatient standard of care and length of stay without an increase in morbidity.”
The study was supported by Verastem, Merck Sharp & Dohme, and Bayer AG.
Lindsey Martin Goodman, MD, of Vanderbilt University Medical Center, is the corresponding author of the Journal of Oncology Practice article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
