Introduction

Neutropenic fever (NF) is the most common complication of anticancer therapy that results in unplanned admission.  The MASCC (Multinational Association for Supportive Care in Cancer) index is a validated tool to assess a patient’s risk of developing complications associated with their NF presentation.   Patients identified as low-risk using the MASCC tool have a <5% incidence of medical complications and can be safely treated with oral antibiotics and/or managed in an ambulatory setting¹.

Methods

A WCMICS project funded in 2013 has established an ambulatory program to manage low-risk NF patients at Peter MacCallum facilitated by a nurse coordinator. Low-risk NF patients are assessed for eligibility for oral antibiotics and suitability for the ambulatory program. Hospital discharge is aimed at 24-48 hours from admission with Hospital-in-the-Home daily visits until neutrophil count recovery (>1.0 x 10⁹ cells/L) then nurse led clinic review.

Results

Twelve patients have been enrolled into the Peter Mac program from February-July 2014; the median age is 57, with eight (67%) men and 10 (83%) solid tumors. Two (17%) patients required readmission for ongoing fevers. Median hospital length of stay is 1.3 days (0.2 – 2.9) versus to 3.6 days (1.1 – 11.0), and median duration of intravenous antibiotics is < 1 day versus 3 days when compared with a historical cohort of low-risk NF patients. These reduced timeframes represent over $2000 per patient episode in health care cost savings².  Patients and clinicians have reported high levels of satisfaction with the program.

Conclusion

The ambulatory program represents a change in culture in the routine management of NF and the uptake while initially slow has shown very promising results. Ambulatory models of care are expected to become increasingly utilised and are likely to lead to significant health care cost savings whilst allowing the patients to remain at home during their neutropenic period.