title: Is parenteral chemotherapy safe in rural hospitals? A prospective audit of neutropenic fever in Albany Hospital, a regional West Australian cancer centre.
abstract: BACKGROUND
  Neutropenic fever is a life-threatening complication of chemotherapy. The widely dispersed population of Australia creates challenges for rural patients in accessing healthcare services. Cancer treatment is particularly, burdensome with patients being forced to relocate to the city for treatment or to endure long and repeated journeys to the city. This study aimed to assess the safety of chemotherapy in a rural centre with a general physician-led model, by analysing neutropenic fever in Albany Hospital, a regional cancer centre in Western Australia.
  
  
  METHODS
  A prospective audit of patients undergoing parenteral chemotherapy was undertaken from March 2014 to March 2015. Cases of neutropenic fever as a consequence of parenteral chemotherapy were analysed and recorded by the Albany Hospital medical registrar.
  
  
  RESULTS
  There were 1294 cycles of chemotherapy administered to 192 patients during the study period. There were 19 cases of neutropenic fever in 16 patients, meaning 8.33% of patients undergoing parenteral chemotherapy had their treatment complicated by neutropenic fever (n = 16/192). The incidence of neutropenic fever was 1.47% per cycle of chemotherapy (n = 19/1294). There were no deaths in the study period. As per guidelines, antibiotics were given within 60 min of arrival in 73.68% of cases (n = 14/19).
  
  
  CONCLUSIONS
  The rate of neutropenic fever observed was similar to rates in other centres worldwide, and the mortality rate was lower than average, with no deaths in the study population. These results provide reassurance with regards to the safe delivery of parenteral chemotherapy in this rural centre with a general physician-led model.
authors.affiliation: Royal Perth Hospital, Perth, Western Australia, Australia.|Royal Australasian College of Physicians, Sydney, New South Wales, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Kennedy
authors.affiliation: Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Auret
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D054869:Clinical Audit; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000453:epidemiology*; D006780:Hospitals, Rural; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification* / Q000188:drug therapy* / Q000401:mortality; D009503:Neutropenia / Q000139:chemically induced / Q000453:epidemiology*; D011446:Prospective Studies; D014904:Western Australia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents
keywords: general physician model; neutropenic fever; parenteral chemotherapy; regional cancer care; rural; safety