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).
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.
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%).
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.
Has not received any funding.
All authors have declared no conflicts of interest.