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Management of febrile neutropenia in the United Kingdom: time for a national trial?

Innes H, Billingham L, Gaunt C, Steven N, Marshall E - Br. J. Cancer (2005)

Bottom Line: Only 38% of respondents stratify patients according to risk and with substantial variation in the criteria defining 'low-risk'.Furthermore, only 22% of clinicians use oral antibiotics as first-line treatment in any patients with FN, but this was significantly greater among clinicians who do compared to those who do not stratify patients by risk, 51 vs 4% (P<0.0001).These findings suggest a slow and/or cautious introduction of newer strategies for the management of low-risk FN in the UK.

View Article: PubMed Central - PubMed

Affiliation: Clatterbridge Centre for Oncology, Bebington, Wirral, Merseyside CH63 4JY, UK.

ABSTRACT
Recent advances in febrile neutropenia (FN) have highlighted the value of risk stratification and the evolving role of oral antibiotics with early hospital discharge in low-risk patients. The aim of this study was to survey whether these advances have been translated into routine clinical practice in the UK. Questionnaires were sent to cancer clinicians across the UK to determine clinicians' routine management of FN, including use of risk stratification, antibiotic regimen and criteria for hospital discharge. In all, 128 clinicians responded, representing 50 cancer departments (83%). Only 38% of respondents stratify patients according to risk and with substantial variation in the criteria defining 'low-risk'. Furthermore, only 22% of clinicians use oral antibiotics as first-line treatment in any patients with FN, but this was significantly greater among clinicians who do compared to those who do not stratify patients by risk, 51 vs 4% (P<0.0001). These findings suggest a slow and/or cautious introduction of newer strategies for the management of low-risk FN in the UK. However, 84% of respondents confirmed their willingness to participate in a trial of oral antibiotics combined with early discharge in low-risk FN.

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Related in: MedlinePlus

Summary of clinicians' antibiotic treatment of low-risk FN.
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fig1: Summary of clinicians' antibiotic treatment of low-risk FN.

Mentions: Of these 128 clinicians, 79 (62%) do not stratify patients with FN into low- and high-risk categories (Figure 1). Of the 49 (38%) who do stratify, three indicated that this was on an occasional or informal basis. Of the 50 oncology/haematology departments represented, 28 (56%) had at least one clinician who stratifies patients by risk and 22 (44%) had no responding clinician who stratifies such episodes by risk. Within the centres represented there was a lack of consistency regarding risk stratification; of the 29 centres from which two or more clinicians responded, there were only five centres from which all responding clinicians stratify by risk.


Management of febrile neutropenia in the United Kingdom: time for a national trial?

Innes H, Billingham L, Gaunt C, Steven N, Marshall E - Br. J. Cancer (2005)

Summary of clinicians' antibiotic treatment of low-risk FN.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2361528&req=5

fig1: Summary of clinicians' antibiotic treatment of low-risk FN.
Mentions: Of these 128 clinicians, 79 (62%) do not stratify patients with FN into low- and high-risk categories (Figure 1). Of the 49 (38%) who do stratify, three indicated that this was on an occasional or informal basis. Of the 50 oncology/haematology departments represented, 28 (56%) had at least one clinician who stratifies patients by risk and 22 (44%) had no responding clinician who stratifies such episodes by risk. Within the centres represented there was a lack of consistency regarding risk stratification; of the 29 centres from which two or more clinicians responded, there were only five centres from which all responding clinicians stratify by risk.

Bottom Line: Only 38% of respondents stratify patients according to risk and with substantial variation in the criteria defining 'low-risk'.Furthermore, only 22% of clinicians use oral antibiotics as first-line treatment in any patients with FN, but this was significantly greater among clinicians who do compared to those who do not stratify patients by risk, 51 vs 4% (P<0.0001).These findings suggest a slow and/or cautious introduction of newer strategies for the management of low-risk FN in the UK.

View Article: PubMed Central - PubMed

Affiliation: Clatterbridge Centre for Oncology, Bebington, Wirral, Merseyside CH63 4JY, UK.

ABSTRACT
Recent advances in febrile neutropenia (FN) have highlighted the value of risk stratification and the evolving role of oral antibiotics with early hospital discharge in low-risk patients. The aim of this study was to survey whether these advances have been translated into routine clinical practice in the UK. Questionnaires were sent to cancer clinicians across the UK to determine clinicians' routine management of FN, including use of risk stratification, antibiotic regimen and criteria for hospital discharge. In all, 128 clinicians responded, representing 50 cancer departments (83%). Only 38% of respondents stratify patients according to risk and with substantial variation in the criteria defining 'low-risk'. Furthermore, only 22% of clinicians use oral antibiotics as first-line treatment in any patients with FN, but this was significantly greater among clinicians who do compared to those who do not stratify patients by risk, 51 vs 4% (P<0.0001). These findings suggest a slow and/or cautious introduction of newer strategies for the management of low-risk FN in the UK. However, 84% of respondents confirmed their willingness to participate in a trial of oral antibiotics combined with early discharge in low-risk FN.

Show MeSH
Related in: MedlinePlus