Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA

Alison Gail Freifeld, Jayashri Sankaranarayanan, Fred Ullrich, Junfeng Sun

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Purpose: The purpose of the study was to determine oncologists' current practice patterns for antibiotic management of low-risk fever and neutropenia (FN) after chemotherapy. Materials and methods: A self-administered survey was developed to query management practices for low-risk FN patients and sent to 3,600 randomly selected American Society of Clinical Oncology physician members; hypothetical case scenarios were included to assess factors influencing decisions about outpatient treatment. Results: Of 3,560 actively practicing oncologists, 1,207 replied (34%). Outpatient antibiotics are used by 82% for selected low-risk FN patients (27% used in them >65% of their patients). Oral levofloxacin (50%), ciprofloxacin (36%), and ciprofloxacin plus amoxicillin/clavulanate (35%) are common outpatient regimens. Fluoroquinolone prophylaxis is used by 45% of oncologists, in a subset of afebrile patients at low risk for FN; growth factors are used adjunctively by 48% for treating low-risk FN. Factors associated with choosing outpatient treatment were: frequency of use in oncologists' own practices, absence of hematologic malignancy, lower patient age, no infiltrate on X-ray, no prior serious infection, shorter expected FN duration, lower creatinine levels, and shorter distance of patient's residence from the hospital. Conclusions: US oncologists, who responded are willing to prescribe outpatient oral antibiotic treatment for low-risk FN, although practices vary considerably and are based on favorable clinical factors. However, practices are often employed that are not recommended for low-risk patients by current guidelines, including fluoroquinolone prophylaxis, adjunctive and/or prophylactic growth factors, and use of levofloxacin for empiric therapy. Educational efforts are needed to better guide cost-effective and supportive care.

Original languageEnglish (US)
Pages (from-to)181-191
Number of pages11
JournalSupportive Care in Cancer
Volume16
Issue number2
DOIs
StatePublished - Feb 1 2008

Fingerprint

Physicians' Practice Patterns
Febrile Neutropenia
Neutropenia
Fever
Drug Therapy
Outpatients
Neoplasms
Levofloxacin
Fluoroquinolones
Ciprofloxacin
Anti-Bacterial Agents
Intercellular Signaling Peptides and Proteins
Clavulanic Acid
Practice Management
Amoxicillin
Risk Management
Hematologic Neoplasms
Therapeutics
Creatinine
X-Rays

Keywords

  • Cancer
  • Chemotherapy
  • Empiric antibiotic treatment
  • Fever
  • Low risk
  • Neutropenia

ASJC Scopus subject areas

  • Oncology

Cite this

Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA. / Freifeld, Alison Gail; Sankaranarayanan, Jayashri; Ullrich, Fred; Sun, Junfeng.

In: Supportive Care in Cancer, Vol. 16, No. 2, 01.02.2008, p. 181-191.

Research output: Contribution to journalArticle

Freifeld, Alison Gail ; Sankaranarayanan, Jayashri ; Ullrich, Fred ; Sun, Junfeng. / Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA. In: Supportive Care in Cancer. 2008 ; Vol. 16, No. 2. pp. 181-191.
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abstract = "Purpose: The purpose of the study was to determine oncologists' current practice patterns for antibiotic management of low-risk fever and neutropenia (FN) after chemotherapy. Materials and methods: A self-administered survey was developed to query management practices for low-risk FN patients and sent to 3,600 randomly selected American Society of Clinical Oncology physician members; hypothetical case scenarios were included to assess factors influencing decisions about outpatient treatment. Results: Of 3,560 actively practicing oncologists, 1,207 replied (34{\%}). Outpatient antibiotics are used by 82{\%} for selected low-risk FN patients (27{\%} used in them >65{\%} of their patients). Oral levofloxacin (50{\%}), ciprofloxacin (36{\%}), and ciprofloxacin plus amoxicillin/clavulanate (35{\%}) are common outpatient regimens. Fluoroquinolone prophylaxis is used by 45{\%} of oncologists, in a subset of afebrile patients at low risk for FN; growth factors are used adjunctively by 48{\%} for treating low-risk FN. Factors associated with choosing outpatient treatment were: frequency of use in oncologists' own practices, absence of hematologic malignancy, lower patient age, no infiltrate on X-ray, no prior serious infection, shorter expected FN duration, lower creatinine levels, and shorter distance of patient's residence from the hospital. Conclusions: US oncologists, who responded are willing to prescribe outpatient oral antibiotic treatment for low-risk FN, although practices vary considerably and are based on favorable clinical factors. However, practices are often employed that are not recommended for low-risk patients by current guidelines, including fluoroquinolone prophylaxis, adjunctive and/or prophylactic growth factors, and use of levofloxacin for empiric therapy. Educational efforts are needed to better guide cost-effective and supportive care.",
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