Low-risk febrile neutropenia

Emergency presentations in cancer patients have increased mortality higher admission rates and longer lengths of inpatient stay than non-cancer patients. There are an increasing number of acute cancer presentations that can be risk assessed for care in an ambulatory emergency setting. Patients with febrile neutropenia are a heterogenous group with a minority developing significant potentially life-threatening complications. Risk assessment tools, such as the Multinational Association for Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia scores have been developed to stratify adult patients with febrile neutropenia. Management of patients with low-risk febrile neutropenia in an outpatient setting is safe and effective. Intravenous and oral antibiotic therapies have been proven to be equally effective in patients with low-risk febrile neutropenia. Combined chemotherapy/immune checkpoint inhibitor (ICI) therapy is increasingly standard of care for a range of cancers. Febrile neutropenia is a common emergency presentation in patients treated with chemotherapy/ICI therapy. Patients receiving chemotherapy/ICI therapy could have more severe presentations with febrile neutropenia illustrated by lower MASCC scores, higher NEWS2 scores, and longer lengths of stay. This may necessitate greater caution in ambulatory management for this cohort. ICI-related neutropenia is a rare adverse event. Early recognition of ICI-related neutropenia in patients treated with chemotherapy/ICI therapy is challenging with the vast majority driven by chemotherapy. Modelling of ambulatory emergency oncology services, such as those for low-risk febrile neutropenia, will be dependent on local service deliveries and pathways, but are key for providing high quality, personalized and sustainable emergency oncology care. Bullet Points There are an increasing number of acute cancer presentations that can be risk assessed for care in an ambulatory emergency setting. Patients with neutropenic fever are a heterogenous group with a minority developing potentially life-threatening complications. Management of patients with low-risk febrile neutropenia in an outpatient setting is safe and effective. Patients receiving chemotherapy/ICI therapy could have more severe febrile neutropenia presentations illustrated by lower MASCC and, higher NEWS2 scores, and longer lengths of stay. Modelling of acute ambulatory oncology services are dependent on local service pathways, but are key for providing high quality, personalized and sustainable acute oncology care.