title: Safety of early discharge for low-risk patients with febrile neutropenia: a multicenter randomized controlled trial.
abstract: OBJECTIVE
  Febrile neutropenia commonly complicates cancer chemotherapy. Outpatient treatment may reduce costs and improve patient comfort but risk progression of undetected medical problems.
  
  
  METHODS
  By using our validated algorithm, we identified medically stable inpatients admitted for febrile neutropenia (neutrophils < 500/μL) after chemotherapy and randomly assigned them to continued inpatient antibiotic therapy or early discharge to receive identical antibiotic treatment at home. Our primary outcome was the occurrence of any serious medical complication, defined as evidence of medical instability requiring urgent medical attention.
  
  
  RESULTS
  We enrolled 117 patients with 121 febrile neutropenia episodes before study termination for poor accrual. We excluded five episodes as ineligible and three because of inadequate documentation of the study outcome. Treatment groups were clinically similar, but sociodemographic imbalances occurred because of block randomization. The median presenting absolute neutrophil count was 100/μL. Hematopoietic growth factors were used in 38% of episodes. The median neutropenia duration was 4 days (range, 1 to 15 days). Five outpatients were readmitted to the hospital. Major medical complications occurred in five episodes (8%) in the hospital arm and four (9%) in the home arm (95% CI for the difference, -10% to 13%; P = .56). No study patient died. Patient-reported quality of life was similar on both arms.
  
  
  CONCLUSIONS
  We found no evidence of adverse medical consequences from home care, despite a protocol designed to detect evidence of clinical deterioration. These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with febrile neutropenia in suitable outpatient settings with appropriate surveillance for unexpected clinical deterioration.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. jtalcott@chpnet.org
authors.forename: James A
authors.initials: JA
authors.lastname: Talcott
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.forename: Robert D
authors.initials: RD
authors.lastname: Siegel
authors.forename: Elizabeth Trice
authors.initials: ET
authors.lastname: Loggers
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Godley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods* / Q000592:standards; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D010351:Patient Discharge / Q000592:standards*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents