Outpatient Treatment Approved for Low-Risk Febrile Neutropenia

Investigators have reported that outpatient management in patients with cancer who have a low risk of severe febrile neutropenia (FN) is an effective and safe option to standard inpatient treatment.

Oliver Teuffel, MD, and colleagues at the National Hospital for Sick Children in Toronto, Ontario, Canada, reviewed 14 randomized controlled trials that assessed the effectiveness and safety of the outpatient management of FN.

FN remains a common complication of chemotherapy in patients with cancer despite advances in infection prevention, the authors pointed out. For several decades, standard treatment has involved inpatient management with broad-spectrum antibiotics.

In recent years, however, research has shown that only a small percentage of patients develop a serious medical complication. As a result, less aggressive treatment approaches have been touted for FN episodes at low risk of severe infection.

Outpatient treatment may refer to a strategy in which patients are hospitalized for treatment and discharged shortly thereafter or to a strategy in which patients are discharged the same day following a brief baseline assessment without hospitalization. In the FN setting, outpatient treatment is appealing because it lowers the risk of hospital-related infection and also reduces costs, which are largely accounted for by inpatient care, they said.

While some centers have already incorporated outpatient management into their clinical practices, the efficacy and safety of outpatient versus inpatient strategies has not been systematically compared.

While some centers have already incorporated outpatient management into their clinical practices, the efficacy and safety of outpatient versus inpatient strategies has not been systematically compared.

The investigators found that inpatient versus outpatient management was not significantly associated with treatment failure (risk ratio [RR], 0.81; 95% CI, 0.55-1.19; P = .28]. Overall mortality was 1.8% (13/742 total; children 5/268 = 1.9%; adults 8/474 = 1.7%), with no differences between the 2 groups (inpatient 7/365; outpatient 6/377; RR, 1.11; 95% CI, 0.41- 3.05; P = .83).

The investigators also examined outcomes by route of drug administration in the outpatient setting in 426 FN episodes treated by intravenous antibiotics and 431 episodes treated by oral antibiotics. Results showed no association between route of drug administration and treatment failure (RR, 0.93; 95% CI, 0.65-1.32; P = .67).

No deaths occurred in 857 FN episodes.

Teuffel and associates emphasized that future research is needed to determine whether outpatient management is feasible in remote areas, given that most trials to date have excluded such patients. Also, considering that efficacy and safety are largely the same with the 2 strategies, future studies will need to examine individual treatment preferences.