title: Outpatient management of febrile neutropenia associated with cancer chemotherapy: risk stratification and treatment review.
abstract: OBJECTIVE
  Strategies for the management of chemotherapy-induced febrile neutropenia (FN), including assessment tools for determining which patients are at low risk for FN complications and can be treated in the outpatient setting, are discussed.
  
  
  CONCLUSIONS
  Due to the potential for life-threatening complications, the development of FN in patients receiving cancer chemotherapy traditionally prompted hospitalization and i.v. antimicrobial therapy, but there is convincing published evidence that an identifiable subset of patients can be safely treated as outpatients. Two validated assessment tools recommended for identifying patients at low risk for FN complications are the Talcott classification system and the Multinational Association for Supportive Care in Cancer (MASCC) risk index; the MASCC index is superior in terms of sensitivity and negative predictive value but has lower specificity. In low-risk FN cases, outpatient oral antimicrobial therapy has been shown to be a safe and effective alternative to i.v. therapy for both inpatients and outpatients; current practice guidelines recommend an oral fluoroquinolone (e.g., ciprofloxacin) in combination with oral amoxicillin-clavulanate. The guidelines emphasize that in certain cases of FN (e.g., those involving prolonged or pronounced neutropenia or serious comorbidities), inpatient i.v. therapy is required.
  
  
  CONCLUSIONS
  Pharmacists can play an important role in the management of chemotherapy-associated FN through involvement in risk assessment to identify candidates for outpatient oral antimicrobial therapy, selection of appropriate pharmacotherapy, drug therapy monitoring, and development of institutional guidelines or pathways.
authors.affiliation: Nisha Pherwani, Pharm.D., BCOP, is Clinical Director, Oncology, Cardinal Health, Innovative Delivery Solutions, Houston, TX. Joanna M. Ghayad, Pharm.D., BCOP, is Medical Science Liaison, United Therapeutics Corporation, Research Triangle Park, NC. Lisa M. Holle, Pharm.D., BCOP, is Assistant Clinical Professor, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs. Emilie L. Karpiuk, Pharm.D., BCPS, is Oncology Pharmacist, Froedtert Hospital, Milwaukee, WI. nisha.pherwani@cardinalhealth.com.
authors.forename: Nisha
authors.initials: N
authors.lastname: Pherwani
authors.affiliation: Nisha Pherwani, Pharm.D., BCOP, is Clinical Director, Oncology, Cardinal Health, Innovative Delivery Solutions, Houston, TX. Joanna M. Ghayad, Pharm.D., BCOP, is Medical Science Liaison, United Therapeutics Corporation, Research Triangle Park, NC. Lisa M. Holle, Pharm.D., BCOP, is Assistant Clinical Professor, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs. Emilie L. Karpiuk, Pharm.D., BCPS, is Oncology Pharmacist, Froedtert Hospital, Milwaukee, WI.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Ghayad
authors.affiliation: Nisha Pherwani, Pharm.D., BCOP, is Clinical Director, Oncology, Cardinal Health, Innovative Delivery Solutions, Houston, TX. Joanna M. Ghayad, Pharm.D., BCOP, is Medical Science Liaison, United Therapeutics Corporation, Research Triangle Park, NC. Lisa M. Holle, Pharm.D., BCOP, is Assistant Clinical Professor, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs. Emilie L. Karpiuk, Pharm.D., BCPS, is Oncology Pharmacist, Froedtert Hospital, Milwaukee, WI.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Holle
authors.affiliation: Nisha Pherwani, Pharm.D., BCOP, is Clinical Director, Oncology, Cardinal Health, Innovative Delivery Solutions, Houston, TX. Joanna M. Ghayad, Pharm.D., BCOP, is Medical Science Liaison, United Therapeutics Corporation, Research Triangle Park, NC. Lisa M. Holle, Pharm.D., BCOP, is Assistant Clinical Professor, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs. Emilie L. Karpiuk, Pharm.D., BCPS, is Oncology Pharmacist, Froedtert Hospital, Milwaukee, WI.
authors.forename: Emilie L
authors.initials: EL
authors.lastname: Karpiuk
mesh_terms: D000553:Ambulatory Care / Q000379:methods* / Q000592:standards; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002986:Clinical Trials as Topic / Q000379:methods; D019468:Disease Management; D064147:Febrile Neutropenia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents