TY - JOUR
T1 - Clinical practice patterns of managing low-risk adult febrile neutropenia during cancer chemotherapy in the USA
AU - Freifeld, Alison
AU - Sankaranarayanan, Jayashri
AU - Ullrich, Fred
AU - Sun, Junfeng
N1 - Funding Information:
Acknowledgments We would like to acknowledge the valuable contributions of JoCarol McNabb, Pharm.D., MPA, to the conception and implementation of the study, during her former association as Assistant Professor with Department of Pharmacy Practice at University of Nebraska Medical Center. This study was supported by a grant from Ortho-McNeill Pharmaceuticals.
PY - 2008/2
Y1 - 2008/2
N2 - 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.
AB - 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.
KW - Cancer
KW - Chemotherapy
KW - Empiric antibiotic treatment
KW - Fever
KW - Low risk
KW - Neutropenia
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U2 - 10.1007/s00520-007-0308-x
DO - 10.1007/s00520-007-0308-x
M3 - Article
C2 - 17943327
AN - SCOPUS:38349095054
SN - 0941-4355
VL - 16
SP - 181
EP - 191
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 2
ER -