Prospective audit of post-chemotherapy febrile neutropenia in patients with solid cancer and lymphoma in two Singaporean cancer centres
Annals of the Academy of Medicine, Singapore
;
: 287-293, 2012.
Article
in English
| WPRIM
| ID: wpr-299636
ABSTRACT
<p><b>INTRODUCTION</b>Febrile neutropenia (FN) is a significant cause of mortality and morbidity in oncology and haematology units worldwide. The overall mortality in hospital surveys in Singapore surveys on post-chemotherapy FN has ranged between 3.0% and 8.8%. However, recent evidence indicates that outpatient management of patients with low-risk FN is safe and cost-effective.</p><p><b>MATERIALS AND METHODS</b>We conducted a prospective audit on a cohort of adult patients with post-chemotherapy FN seen at 2 local public sector cancer centres over a 1-year period in order to define their epidemiological characteristics and outcomes, and also to assess the uptake of early discharge/outpatient management strategies for these patients.</p><p><b>RESULTS</b>We reviewed 306 FN episodes from 248 patients. Patient characteristics and outcomes were similar between both institutions. Eleven (3.7%) FN episodes were managed as outpatient and none developed complications. Overall 30-day mortality was 6.6%, while the median length of stay (LOS) was 7 days (IQR 4 to 11 days). The only independent risk factor for mortality was severe sepsis (OR13.19; 95% CI 1.98 to 87.7; P = 0.008). Factors independently associated with a longer LOS were vancomycin prescription (coefficient 0.25; 95% CI 0.08 to 0.41; P = 0.003), longer duration of intravenous antibiotics (coefficient 0.08; 95% CI 0.06 to 0.10; P <0.001), and prior review by an infectious diseases physician (coefficient 0.16; 95% CI 0.01 to 0.31; P = 0.034).</p><p><b>CONCLUSION</b>This audit demonstrated that mortality from FN in our 2 cancer centres is low and comparable to international institutions. It also demonstrates that outpatient management of FN is safe in selected patients, and can be further expanded for right-siting of resources.</p>
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Singapore
/
Bacterial Infections
/
Epidemiology
/
Prospective Studies
/
Cohort Studies
/
Therapeutic Uses
/
Drug Therapy
/
Fever
/
Anti-Bacterial Agents
/
Mycoses
Type of study:
Etiology study
/
Incidence study
/
Observational study
/
Risk factors
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
Asia
Language:
English
Journal:
Annals of the Academy of Medicine, Singapore
Year:
2012
Type:
Article
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