[Modalities of management of cancer patients with febrile neutropenia in the oncology emergency unit of Gustave-Roussy and their related costs].
BACKGROUND
Febrile neutropenia (FN) is a severe chemotherapy side effect. Hospitalization is recommended for FN episode of high-risk (HR) of complications. Management of FN at lower risk of complications remains unclear.


METHODS
This is a prospective observation study in patients with solid tumors admitted to the emergency department FN. Collected data included demographics, clinical, biological, therapeutic costs, MASCC score and complications.


RESULTS
Hundred and thirty-seven consecutive FN were recorded in 128 patients. Twenty-six FN (19%) were managed at home (all of them had a MASCC score ≥ 21); 111 (81%) were treated at hospital of which 37 NF were at HR of complications based on clinical and biological parameters (all of them had a MASCC score < 21) and for 74 of them the admission could be discussed (MASCC < 20 or ≥ 20). This group of patients was considerate with intermediate risk (IR). All IR patients were treated with the same antibiotics than outpatients, i.e. ceftriaxone in 36 cases (49%) or amoxicillin/clavulanic acid and ciprofloxacin in 38 cases (51%). For these 74 cases, any severe complication was recorded. Antibiotics were adapted for only 12% of these patients according to bacteriology results.


CONCLUSIONS
This study showed the limits of the MASCC score. We did not observe any severe complications in patients admitted to the hospital according to clinical and biological parameters and with the high risk score MASCC. This study had some methodological bias but it allowed us to estimate the cost of the different ways of management and the difficulties to decide the hospitalization in FN.
Institut Gustave-Roussy, Département d'épidémiologie et de biostatistique, 114, rue Édouard-Vaillant, 94805 Villejuif, France, Université de Paris Sud, 94270 Paris, France.
Isabelle
I
Borget
Institut Gustave-Roussy, Service d'urgences médicales et ontologiques, Villejuif, France.
Sami
S
Antoun
Institut Gustave-Roussy, Département de microbiologie, Villejuif, France.
Elisabeth
E
Chachaty
Institut Gustave-Roussy, Département de microbiologie, Villejuif, France.
Bertrand
B
Gachot
Institut Gustave-Roussy, Service d'urgences médicales et ontologiques, Villejuif, France.
Arif
A
Alibay
Institut Gustave-Roussy, Service d'oncologie médicale, Villejuif, France.
Mario
M
Di Palma
Institut Gustave-Roussy, Service d'urgences médicales et ontologiques, Villejuif, France.
Mansouria
M
Merad
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects; D002173:Cancer Care Facilities; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005602:France; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone
MASCC scoring system; complications; cost; febrile neutropenia; outpatient management