Background; Febrile neutropenia (FN) is a common complication of cancer chemotherapy. Febrile neutropenic patients are a heterogeneous population with variable outcomes. The aim of this study was to compare the patients’ characteristics, outcomes, and clinical decisions made against the Multinational Association for Supportive Care in Cancer (MASCC) score to describe differences between local guidelines and international benchmarks.
Patients and methods; This is a retrospective analysis of FN admissions at Prince of Wales Hospital (POWH) from 2015-2019. The medical records of adults (≥18 years), admitted with fever ≥38◦C, neutropenia (a count of ≤1000 x 109/L), chemotherapy, and a solid tumour were reviewed. The medical records were extracted whenever the International Classification of Disease- version 10 (ICD-10) criteria were met.
Results; Out of 275 queried episodes, 111 FN admissions were included in the final analysis. Low-risk MASCC score represented 73.9 % of the admissions with a median length of stay of 5-days. Medical complications occurred within 69% of the high-risk group and 11% of the low-risk group P <0.001. MASCC score was a significant predictor of complications with sensitivity, specificity, positive predictive, and negative predictive value of 90%, 65%, 72%, and 86% respectively. Also, time to antibiotic administration (TTA) was a significant predictor of complication with ROC AUC 0.637 P<0.045, however, had no impact length of stay. The majority of patients in both groups were not bacteremic (75.6%), yet Gram-negative bacteremia was more prevalent in the high-risk group. There were no mortalities or intensive care unit admission in the low-risk group.
Conclusions; Low-risk MASCC score is a predictor for low complication rate in FN admissions at POW from 2015-2019. These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with FN in suitable outpatient settings with vigilant standardised surveillance for unexpected clinical deterioration.