Expert Point of View: Alison Freifeld, MD

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The EORTC Infectious Diseases Group Trial XV “is a long-awaited study because it finally is an investigation of outpatient management of low-risk fever and neutropenia in a large number of patients,” Alison Freifeld, MD, of the University of Nebraska Medical Center in Omaha, commented in an interview with The ASCO Post. “It actually confirms what we have known for a long time, which is that low-risk patients who are carefully selected by the MASCC scoring criteria generally do well when they receive empiric oral antibiotics in the outpatient setting.”

A 2008 survey of practicing oncologists in the United States found that 82% were already using outpatient oral antibiotic therapy for their low-risk patients,1 according to Dr. Freifeld. Thus, “the study by Kern et al essentially validates an approach that has been employed by most [U.S.] oncologists for a number of years now, but the data provide strong support for the safety and efficacy of early discharge for low-risk febrile neutropenic patients who can tolerate oral antibiotic therapy.” (See MASCC Scoring System on page 28.)

Feasibility of Discharge

The impact of oral antibiotic therapy in this population in terms of cost, convenience, and other such outcomes will ultimately depend on the feasibility of discharge, she said, concurring with the editorialists. “The issue will be whether or not the patient and the physician can manage the complexities of fever and neutropenia in the outpatient setting.”

The study points to at least two additional topics for research, according to Dr. Freifeld. “One is to further refine how to choose the lowest-risk patients [as candidates for discharge]; there are still patients who require readmission—about 5% in this study—so we need to better define that,” she elaborated. “And secondly, we need to understand the social, psychological, and physical barriers that prevent us from being able to treat more patients at home. I think that these issues are important to evaluate in research studies so that we can facilitate more patients being treated outside of a hospital setting.” ■

Disclosure: Dr. Freifeld repoted no potential conflicts of interest.


1. Freifeld A, Sankaranarayanan J, Ullrich F, et al: Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA. Support Care Cancer 16:181-191, 2008.

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