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Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients

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Abstract

Background

We treated low-risk febrile neutropenic cancer patients utilizing two standard outpatient antibiotic pathways: oral ampicillin/clavulanate (500 mg) and ciprofloxacin (500 mg) or intravenous ceftazidime (2 g) and clindamycin (600 mg) every 8 h. The objectives were to determine the success of outpatient treatment of low-risk febrile neutropenia, to identify factors predicting outpatient failure, and to determine mortality related to the febrile episode.

Methods

Eligibility criteria included solid tumor diagnosis, stable vital signs, temperature ≥38.0°C, absolute neutrophil count (ANC) of <1000/ml, patient compliance, no significant organ dysfunction, ability to tolerate oral medication and fluids for oral pathway, residence within 30 miles of the institution, 24-h caregiver, and telephone and transportation access.

Results

There were 257 febrile episodes in 191 patients meeting the criteria. Patients were treated during March 1998 through February 2000. Median age was 48 (range, 17–77) years, and 60% (n=153) had an entry ANC of <100/ml; 205 (80%) febrile episodes successfully responded to outpatient treatment, and 52 (20%) were hospitalized. Logistic regression analysis showed the following were related to hospitalization: mucositis >grade 2 (p <0.002); Zubrod performance status ≥2 (p=0.029); ANC <100/ml (p=0.039), and age ≥70 years (p=0.048).

Conclusions

Outpatient treatment of low-risk febrile neutropenic cancer patients utilizing standard treatment pathways is associated with minimal morbidity and mortality and should be considered an acceptable standard of care with appropriate infrastructure available to provide strict and careful follow-up while on treatment. Certain factors are associated with higher risk of hospitalization and should be further examined in eligible patients with low-risk febrile neutropenia.

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Authors and Affiliations

  1. Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 437, Houston, TX, 77030, USA

    Carmen P. Escalante, Mary Ann Weiser, Ellen Manzullo, Tony Lam, Vi Ho, Rosalie Valdres, Eva Lu Lee, Noemi Badrina & Sally Fernandez

  2. Department of Sarcoma, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Robert Benjamin

  3. Department of Medical Breast Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Edgardo Rivera

  4. Department of Practice Outcomes, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Yvette DeJesus

  5. Department of Infectious Diseases, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Kenneth Rolston

Authors
  1. Carmen P. Escalante
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  2. Mary Ann Weiser
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  3. Ellen Manzullo
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  4. Robert Benjamin
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  5. Edgardo Rivera
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  6. Tony Lam
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  7. Vi Ho
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  8. Rosalie Valdres
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  9. Eva Lu Lee
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  10. Noemi Badrina
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  11. Sally Fernandez
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  12. Yvette DeJesus
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  13. Kenneth Rolston
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Corresponding author

Correspondence to Carmen P. Escalante.

Additional information

Presented at the 2002 American Society of Clinical Oncology, Orlando, Florida, USA.

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Escalante, C.P., Weiser, M.A., Manzullo, E. et al. Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients. Support Care Cancer 12, 657–662 (2004). https://doi.org/10.1007/s00520-004-0613-6

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  • DOI: https://doi.org/10.1007/s00520-004-0613-6

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