title: Inpatient versus outpatient management of neutropenic fever in gynecologic oncology patients: is risk stratification useful?
abstract: OBJECTIVE
  This study aimed to evaluate the utility of risk stratification of gynecologic oncology patients with neutropenic fever (NF).
  
  
  METHODS
  A retrospective chart review of gynecologic cancer patients admitted with NF from 2007 to 2011 was performed, wherein demographic, oncologic, and NF characteristics (hospitalization length, complications, and death) were collected. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score was calculated; low risk was considered ≥ 21. SAS 9.2 was used for statistical analyses.
  
  
  RESULTS
  Eighty-three patients met the study criteria. Most (92%) were Caucasian and had advanced stage disease (71%). Primary tumors were 58% ovary, 35% endometrium, and 6% cervix. All patients were receiving chemotherapy on admission (72% for primary, 28% for recurrent disease). Forty-eight percent had a positive culture, and most (58%) positive cultures were urine. Seventy-six percent of patients were considered low risk. High-risk patients were more likely to have a severe complication (10% versus 50%, p=0.0003), multiple severe complications (3% versus 20%, p=0.0278), ICU admission (2% versus 40%, p<0.0001), overall mortality (2% versus 15%, p=0.0417), and death due to neutropenic fever (0% versus 15%, p=0.0124). MASCC had a positive predictive value of 50% and negative predictive value of 90%. The median MASCC score for all patients was 22 (range, 11-26), but the median MASCC score for those with death or a severe complication was 17 (range, 11-24).
  
  
  CONCLUSIONS
  Based on this pilot data, MASCC score appears promising in determining suitability for outpatient management of NF in gynecologic oncology patients. Prospective study is ongoing to confirm safety and determine impact on cost.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Oklahoma Health Sciences Center, 800 NE 10th Street, Oklahoma City, OK 71304, USA. camille-gunderson@ouhsc.edu
authors.forename: Camille C
authors.initials: CC
authors.lastname: Gunderson
authors.forename: Regina
authors.initials: R
authors.lastname: Farrell
authors.forename: Brian C
authors.initials: BC
authors.lastname: Dinh
authors.forename: Eric D
authors.initials: ED
authors.lastname: Thomas
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
authors.forename: Jacob K
authors.initials: JK
authors.lastname: Lauer
authors.forename: Lydia
authors.initials: L
authors.lastname: Kao
authors.forename: Sheeva
authors.initials: S
authors.lastname: Chopra
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005833:Genital Neoplasms, Female / Q000150:complications / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents
keywords: Chemotherapy; Neutropenic fever; Risk stratification