title: Health-related quality of life anticipated with different management strategies for febrile neutropenia in adult cancer patients.
abstract: OBJECTIVE
  To describe anticipated health-related quality of life (HRQL) for different hypothetical strategies of febrile neutropenia (FN) management in adult cancer patients.
  
  
  METHODS
  Seventy-eight adult cancer patients were enrolled. Our study considered four different hypothetical treatment strategies for FN: (1) entire inpatient management with intravenous (IV) antibiotics; (2) oral treatment at home after an initial observation in hospital with IV antibiotics; (3) entire outpatient management with IV antibiotics; and (4) entire outpatient management with oral antibiotics. Initially, patients were asked to rank the different treatment strategies for FN based on their personal preference. Subsequently, HRQL was rated using visual analog scale (VAS), time trade-off (TTO), and willingness-to-pay (WTP).
  
  
  RESULTS
  Seventy-five percent of all respondents preferred an outpatient strategy for FN (36% oral, 21% intravenous, 18% early discharge). Further, outpatient strategies were associated with higher mean VAS scores (possible range 0-10) (oral: 6.1 (standard deviation (SD) 3.1); intravenous: 6.2 (SD 2.2); early discharge: 5.7 (SD 2.1)) as compared to inpatient care (5.3 (SD 2.9)). On the aggregate level, patients were willing to give up between 9 and 10 weeks of their life (TTO; corresponding to <1% of remaining life expectancy) and to pay between $255 and $327 Canadian dollars (WTP) to avoid treatment in hospital.
  
  
  CONCLUSIONS
  Our study indicates that the majority of adult cancer patients would prefer an outpatient strategy for FN. However, patients' preferences vary substantially at the individual level. Implementation of outpatient strategies into routine clinical practice should consider this variability.
authors.affiliation: Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: O
authors.initials: O
authors.lastname: Teuffel
authors.forename: S
authors.initials: S
authors.lastname: Cheng
authors.forename: M C
authors.initials: MC
authors.lastname: Ethier
authors.forename: C
authors.initials: C
authors.lastname: Diorio
authors.forename: J
authors.initials: J
authors.lastname: Martino
authors.forename: C
authors.initials: C
authors.lastname: Mayo
authors.forename: R
authors.initials: R
authors.lastname: Wing
authors.forename: L
authors.initials: L
authors.lastname: Sung
authors.forename: S M H
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods / Q000523:psychology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002170:Canada; D005260:Female; D005334:Fever / Q000209:etiology / Q000628:therapy*; D005382:Financing, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D009503:Neutropenia / Q000209:etiology / Q000628:therapy*; D010147:Pain Measurement; D057240:Patient Preference; D011788:Quality of Life; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents