title: Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis.
abstract: BACKGROUND
  In some centers, outpatient management for cancer patients with low-risk febrile neutropenia (FN) has been implemented into routine clinical practice. Our objective was to evaluate the current level of evidence before supporting widespread adoption of outpatient management for this population.
  
  
  METHODS
  We systematically reviewed randomized controlled trials evaluating efficacy and safety of outpatient management of FN.
  
  
  RESULTS
  From 1448 reviewed articles, 14 studies were included for meta-analysis. (i) Inpatient versus outpatient setting (6 studies) was not significantly associated with treatment failure [risk ratio 0.81; 95% confidence interval (CI) 0.55-1.19; P = 0.28]. Death occurred in 13 of 742 FN episodes with no difference between the two groups (risk ratio 1.11; 95% CI 0.41-3.05; P = 0.83). (ii) Outpatient oral versus outpatient parenteral antibiotics (8 studies) were similarly efficacious with no association between route of drug administration and treatment failure (risk ratio 0.93; 95% CI 0.65-1.32; P = 0.67). No death occurred in 857 FN episodes.
  
  
  CONCLUSIONS
  Based on the current literature, outpatient treatment of FN is a safe and efficacious alternative to inpatient management. Variation between studies in terms of time to discharge, choice of antibiotic class, and age of study population may limit the interpretation of the data.
authors.affiliation: Division of Haematology/Oncology; Child Health Evaluative Sciences, The Hospital for Sick Children.
authors.forename: O
authors.initials: O
authors.lastname: Teuffel
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children.
authors.forename: M C
authors.initials: MC
authors.lastname: Ethier
authors.affiliation: Department of Health Policy Management and Evaluation, University of Toronto; Department of Medicine, University Health Network.
authors.forename: S M H
authors.initials: SMH
authors.lastname: Alibhai
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children; Department of Health Policy Management and Evaluation, University of Toronto; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Beyene
authors.affiliation: Division of Haematology/Oncology; Child Health Evaluative Sciences, The Hospital for Sick Children; Department of Health Policy Management and Evaluation, University of Toronto. Electronic address: lillian.sung@sickkids.ca.
authors.forename: L
authors.initials: L
authors.lastname: Sung
mesh_terms: D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D005334:Fever / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D009369:Neoplasms / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents