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Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

5419 - Febrile Neutropenia Management And Concordance Of Institutional Protocol With Clinical Practice

Date

22 Oct 2018

Session

Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care

Presenters

André Oliveira

Citation

Annals of Oncology (2018) 29 (suppl_8): viii603-viii640. 10.1093/annonc/mdy300

Authors

A.F. Oliveira, L. Bretes, I. Furtado, B.E. Gosalbez Pequeno, J.G. Magalhaes

Author affiliations

  • Medical Oncology, Centro Hospitalar Universitário Algarve, 8000-386 - Faro/PT
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Resources

Abstract 5419

Background

Febrile Neutropenia (NF) is an oncologic emergency defined as fever (oral temperature greater than 38.3 °C) and neutrophil count <500. It is one of the most common complications due to chemotherapy. NF is responsible for a considerable morbidity since 20% to 30% of the patients present complications that require hospitalization, with global hospital mortality around 10%. The objective of this study is to evaluate the initial approach to patients with NF in Oncology Day Unit (ODU), Service of Unplanned Care (SUC) and Emergency (ER) and compare the procedures performed in these patients with the protocol at our institution, which is based on guidelines (ESMO/NCCN).

Methods

Retrospective, unicentric study, with the consultation of the clinical records of the patients who presented at ODU, SUC, ER and hospitalized in the Oncology ward with FN and cancer, during a period of 3 months in 2017. Patients were diagnosed by the attending physician with fever and N < 500 or with fever and N < 1000 and> 500, with a drop expected in the next 7 days.

Results

There were 21 episodes, all with solid tumors. The most frequent sites were lung (23%), breast (19%) and colon (17%). 61% of the patients had stage IV cancer. About half developed FN after 1st cycle of chemotherapy. 52% were male, with a mean age of 66.2 years (36-86). In terms of infectious site, the most frequent were fever without a focus (42%) followed by respiratory, skin and urinary tract infections. The MASCC was described in 20% of the cases. The first antibiotic therapy was performed in the SUC in 30% of the cases, in the ER in 65% and in the ODU in 10%. The hospitalization was performed in 11 patients with a median of 13 days of hospitalization. 8 patients underwent outpatient therapy, 3 of whom were subsequently hospitalized for FN. 60% of the patients were treated with G-CSF (N < 500). There were no deaths. The total agreement between clinical practice and the institutional protocol was 17/21 (81%).

Conclusions

Not all patients initiated antibiotic therapy at SUC. The description of the MASCC in the clinical record would be ideal for arguing the therapeutic decision. We have found the overuse of G-CSF. This analysis served to investigate and improve our approach in FN. Protocols can improve the consistency and quality of care.

Clinical trial identification

Legal entity responsible for the study

Centro Hospitalar Universitário Algarve.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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