Funding: These guidelines were developed independently through funding from Victorian Integrated Cancer Services. The Western and Central Melbourne Integrated Cancer Service (WCMICS), one of three metropolitan and five regional Integrated Cancer Services funded by the Victorian Department of Human Services to implement the Victorian Government's Cancer Services Framework across Victoria, administered this funding.
Use of risk stratification to guide ambulatory management of neutropenic fever
Article first published online: 28 JAN 2011
© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians
Internal Medicine Journal
Special Issue: Australian consensus guidelines for the management of neutropenic fever in adult cancer patients
Volume 41, Issue 1b, pages 82–89, January 2011
How to Cite
Worth, L. J., Lingaratnam, S., Taylor, A., Hayward, A. M., Morrissey, S., Cooney, J., Bastick, P. A., Eek, R. W., Wei, A. and Thursky, K. A. (2011), Use of risk stratification to guide ambulatory management of neutropenic fever. Internal Medicine Journal, 41: 82–89. doi: 10.1111/j.1445-5994.2010.02339.x
Conflict of interest: The following working group members are consultants or advisory committee members or receive honoraria, fees for service, or travel assistance (independent of research-related meetings) form; or have research or other associations with the organizations listed: Ian Davis – Novartis, Pfizer, GlaxoSmithKline, Schering-Plough; Andrew Grigg – Amgen, Gilead, Merck Sharp & Dohme, Novartis, Pfizer, Schering Plough, Sue Kirsa – Roche, Schering Plough, Amgen, Hospira, Alphapharm; Senthil Lingaratnam – Victorian Integrated Cancer Services; Orla Morrissey – Gilead, Merck Sharp & Dohme, Orphan, Pfizer, Schering Plough; William Renwick – Roche; Monica Slavin – Gilead, Merck Sharp & Dohme, Pfizer, Schering Plough; Brian Stein – Merck Serono; Constantine Tam – GSK, Roche; Karin Thursky – Gilead, Merck Sharp & Dohme, Pfizer, Schering Plough; Andrew Wei – Celgene, Hospira, Novartis.
- Issue published online: 28 JAN 2011
- Article first published online: 28 JAN 2011
- Received 30 August 2010; accepted 31 August 2010.
- ambulatory care;
- risk stratification;
- neutropenic fever;
- early discharge
Utilization of risk-stratification tools in the setting of neutropenic fever is currently limited by inadequate knowledge and lack of awareness. Within this context, the approach to management of low-risk patients with neutropenic fever is inconsistent with the available evidence across many Australian treating centres. These clinical guidelines define and clarify an accepted standard of care for this patient group given the current evidence base. The Multinational Association for Supportive Care in Cancer risk index is presented as the preferred risk assessment tool for determining patient risk. Suitability of ambulatory care within specific patient populations is discussed, with defined eligibility criteria provided to guide clinical decision-making. Detailed recommendations for implementing appropriate ambulatory strategies, such as early discharge and outpatient antibiotic therapy, are also provided. Due consideration is given to infrastructural requirements and other supportive measures at a resourcing and operational level. An analysis of the relevant health economics is also presented.