Citation: Supportive Care in Cancer. 2019, 27(1)
Author: Forde C.; Marshall E.; Cooksley T.; Young A.; Jones P.; Clarke M.; Wilson R.H.; Coyle V.
Abstract: Introduction For patients presenting with neutropenic sepsis (NS) clinicians are encouraged to assess their risk of septic complications using a validated tool. This approach is promoted by national UK NS guidelines (NICE), and international organisations such as MASCC, ASCO and ESMO. Methods 53 local adult NS policies from across the UK were reviewed for approaches to risk stratification, along with 217 responses from an electronic survey of clinicians' standard clinical practice. Results 53% of policies encourage identification of 'low risk' patients within 24 hours of presentation and consider discharge on oral antibiotics prior to 48 hours in hospital (45% calculate a MASCC score, 8% their own criteria). This compares with approximately a third of policies when practice was reviewed in 2012. 40% of clinicians routinely risk stratify patients within 24 hours (70% MASCC tool, 30% institution's own risk scoring system, Modified Early Warning Score or Clinical Index of Stable Febrile Neutropenia). Awide range of approaches to early oral antibiotics, discharge and ambulatory care are described in policies and by clinicians. There is limited evidence of empirical oral antibiotics for low risk patients (9% policies, 5% clinicians) but a preference for initial intravenous antibiotics for all patients.
Conclusions There has been some enhanced uptake of routine risk assessment and consideration of early outpatient oral antibiotics for low risk patients. However this does not appear to be widespread standard practice. Further efforts are therefore required to improve the usability and performance of currently validated tools and optimise and promote low risk management care pathways.
