Skip to main content
Erschienen in: Supportive Care in Cancer 9/2018

19.04.2018 | Commentary

A novel approach to improving ambulatory outpatient management of low risk febrile neutropenia: an Enhanced Supportive Care (ESC) clinic

verfasst von: Tim Cooksley, Geraldine Campbell, Tamer Al-Sayed, Lisa LaMola, Richard Berman

Erschienen in: Supportive Care in Cancer | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Outpatient management of low risk febrile neutropenia patients (LRFN) identified by the MASCC score is a safe and effective strategy. Early supportive care has been shown to improve outcomes in patients with care. We developed an innovative ambulatory outpatient “enhanced supportive care” (ESC) clinic combining emergency oncology and supportive care through which we incorporated the management of patients with LRFN.

Methods

An ESC clinic was started in January 2017 at a tertiary cancer hospital in the North West of England. An integral part of the clinic was an ambulatory pathway for patients presenting with LRFN. Patients with a MASCC score ≥ 21 and an Early Warning Score ≤ 3 were potentially eligible for the pathway. Suitable patients were managed with oral amoxicillin/clavulanic acid (500/125 mg TDS) and ciprofloxacin (500 mg BD) or moxifloxacin 400 mg OD if penicillin allergic. All patients had one dose of intravenous meropenem on arrival.

Results

In its first year, 68 patients with LRFN were managed through the clinic. Table 1 shows the demographic data of the patients. Six (8.8%) patients had a 7-day readmission. There were no serious complications in the cohort.

Conclusion

The ESC clinic maybe an effective method for delivering outpatient ambulatory management of patients with LRFN.
Literatur
1.
Zurück zum Zitat Klastersky J, Paesmans M (2013) The Multinational Association for Supportive Care in Cancer (MASCC) risk score: 10 years of use for identifying low risk neutropenic cancer patients. Support Care Cancer 21:1487–1495CrossRefPubMed Klastersky J, Paesmans M (2013) The Multinational Association for Supportive Care in Cancer (MASCC) risk score: 10 years of use for identifying low risk neutropenic cancer patients. Support Care Cancer 21:1487–1495CrossRefPubMed
2.
Zurück zum Zitat Teuffel O, Ethier M, Alibhal S et al (2011) Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol 22:2358–2365CrossRefPubMed Teuffel O, Ethier M, Alibhal S et al (2011) Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Ann Oncol 22:2358–2365CrossRefPubMed
3.
Zurück zum Zitat Cooksley T, Holland M, Klastersky J (2015) Ambulatory outpatient management of patients with low risk febrile neutropaenia. Acute Med 14(4):178–181PubMed Cooksley T, Holland M, Klastersky J (2015) Ambulatory outpatient management of patients with low risk febrile neutropaenia. Acute Med 14(4):178–181PubMed
4.
Zurück zum Zitat Knight T, Ahn S, Rice TW, Cooksley T (2017) Acute oncology care: a narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors. Eur J Intern Med 45:59–65CrossRefPubMed Knight T, Ahn S, Rice TW, Cooksley T (2017) Acute oncology care: a narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors. Eur J Intern Med 45:59–65CrossRefPubMed
5.
Zurück zum Zitat Cooksley T, Rice T (2017) Emergency oncology: development, current position and future direction in the US and UK. Support Care Cancer 25(1):3–7CrossRefPubMed Cooksley T, Rice T (2017) Emergency oncology: development, current position and future direction in the US and UK. Support Care Cancer 25(1):3–7CrossRefPubMed
6.
Zurück zum Zitat Hui D, Bruera E (2016) Integrating palliative care into the trajectory of cancer care. Nat Rev Clin Oncol 13(3):159–171CrossRefPubMed Hui D, Bruera E (2016) Integrating palliative care into the trajectory of cancer care. Nat Rev Clin Oncol 13(3):159–171CrossRefPubMed
7.
Zurück zum Zitat Temel J, Greer J, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742CrossRefPubMed Temel J, Greer J, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742CrossRefPubMed
8.
Zurück zum Zitat Klastersky J, Paesmans M, Rubenstein E et al (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Onc 18:3038–3051CrossRef Klastersky J, Paesmans M, Rubenstein E et al (2000) The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Onc 18:3038–3051CrossRef
9.
Zurück zum Zitat Jones M (2012) NEWSDIG: the national early warning score development and implementation group. Clin Med 12(6):501–503CrossRef Jones M (2012) NEWSDIG: the national early warning score development and implementation group. Clin Med 12(6):501–503CrossRef
10.
Zurück zum Zitat Mattison G, Bilney M, Haji-Michael P, Cooksley T (2016) A nurse-led protocol improves the time to first dose intravenous antibiotics in septic patients post chemotherapy. Support Care Cancer 24(12):5001–5005CrossRefPubMed Mattison G, Bilney M, Haji-Michael P, Cooksley T (2016) A nurse-led protocol improves the time to first dose intravenous antibiotics in septic patients post chemotherapy. Support Care Cancer 24(12):5001–5005CrossRefPubMed
11.
Zurück zum Zitat Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M, Ramchandani A, Martínez J, Hernando Cubero J, Espinosa J, Martínez de Castro E, Ghanem I, Beato C, Blasco A, Garrido M, Bonilla Y, Mondéjar R, Arcusa Lanza MÁ, Aragón Manrique I, Manzano A, Sevillano E, Castañón E, Cardona M, Gallardo Martín E, Pérez Armillas Q, Sánchez Lasheras F, Ayala de la Peña F (2015) Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the clinical index of stable febrile neutropenia in a prospective cohort of patients from the FINITE study. J Clin Onc 33:465–471CrossRef Carmona-Bayonas A, Jiménez-Fonseca P, Virizuela Echaburu J, Antonio M, Font C, Biosca M, Ramchandani A, Martínez J, Hernando Cubero J, Espinosa J, Martínez de Castro E, Ghanem I, Beato C, Blasco A, Garrido M, Bonilla Y, Mondéjar R, Arcusa Lanza MÁ, Aragón Manrique I, Manzano A, Sevillano E, Castañón E, Cardona M, Gallardo Martín E, Pérez Armillas Q, Sánchez Lasheras F, Ayala de la Peña F (2015) Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the clinical index of stable febrile neutropenia in a prospective cohort of patients from the FINITE study. J Clin Onc 33:465–471CrossRef
12.
Zurück zum Zitat Teh BW, Brown C, Joyce T, Worth LJ, Slavin MA, Thursky KA (2017 Oct 10) Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre. Support Care Cancer. https://doi.org/10.1007/s00520-017-3921-3. [Epub ahead of print] Teh BW, Brown C, Joyce T, Worth LJ, Slavin MA, Thursky KA (2017 Oct 10) Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre. Support Care Cancer. https://​doi.​org/​10.​1007/​s00520-017-3921-3. [Epub ahead of print]
13.
Zurück zum Zitat Kern W, Marchetti O, Drgona L et al (2013) Oral antibiotics for fever in low-risk neutropenic patients with cancer: a double-blind, randomized, multicentre trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxicillin/clavulanic acid combination therapy—EORTC Infectious Diseases Group trial XV. J Clin Onc 31:1149–1156CrossRef Kern W, Marchetti O, Drgona L et al (2013) Oral antibiotics for fever in low-risk neutropenic patients with cancer: a double-blind, randomized, multicentre trial comparing single daily moxifloxacin with twice daily ciprofloxacin plus amoxicillin/clavulanic acid combination therapy—EORTC Infectious Diseases Group trial XV. J Clin Onc 31:1149–1156CrossRef
14.
Zurück zum Zitat Dzienis MR, Shahidzadeh Mahani A (2017) Report on outpatient management of patients with neutropenic fever in a tertiary hospital. Intern Med J 47:122–123CrossRefPubMed Dzienis MR, Shahidzadeh Mahani A (2017) Report on outpatient management of patients with neutropenic fever in a tertiary hospital. Intern Med J 47:122–123CrossRefPubMed
15.
Zurück zum Zitat Ahn S, Rice TW, Yeung SJ, Cooksley T (2018) Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Support Care Cancer 26(5):1465–1470PubMed Ahn S, Rice TW, Yeung SJ, Cooksley T (2018) Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Support Care Cancer 26(5):1465–1470PubMed
Metadaten
Titel
A novel approach to improving ambulatory outpatient management of low risk febrile neutropenia: an Enhanced Supportive Care (ESC) clinic
verfasst von
Tim Cooksley
Geraldine Campbell
Tamer Al-Sayed
Lisa LaMola
Richard Berman
Publikationsdatum
19.04.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Supportive Care in Cancer / Ausgabe 9/2018
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4194-1

Weitere Artikel der Ausgabe 9/2018

Supportive Care in Cancer 9/2018 Zur Ausgabe

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

25.04.2024 NSCLC Nachrichten

Das Risiko für Rezidiv oder Tod von Patienten und Patientinnen mit reseziertem ALK-positivem NSCLC ist unter einer adjuvanten Therapie mit dem Tyrosinkinase-Inhibitor Alectinib signifikant geringer als unter platinbasierter Chemotherapie.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

ICI-Therapie in der Schwangerschaft wird gut toleriert

Müssen sich Schwangere einer Krebstherapie unterziehen, rufen Immuncheckpointinhibitoren offenbar nicht mehr unerwünschte Wirkungen hervor als andere Mittel gegen Krebs.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.