title: Approach to evaluation of fever in ambulatory cancer patients receiving chemotherapy: A systematic review.
abstract: OBJECTIVE
  To define the optimal model of care for patients receiving outpatient chemotherapy who experience a fever. Fever is a common symptom in patients receiving chemotherapy, but the approach to evaluation of fever is not standardized.
  
  
  METHODS
  We conducted a search for existing guidelines and a systematic review of the primary literature from database inception to November 2015. Full-text reports and conference abstracts were considered for inclusion. The search focused on the following topics: the relationship between temperature and poor outcome; predictors for the development of febrile neutropenia (FN); the timing, location, and personnel involved in fever assessment; and the provision of information to patients receiving chemotherapy.
  
  
  RESULTS
  Eight guidelines and 38 studies were included. None of the guidelines were directly relevant to the target population because they dealt primarily with the management of FN after diagnosis. The primary studies tended to include fever as one of many symptoms assessed in the setting of chemotherapy. Temperature level was a weak predictor of poor outcomes. We did not find validated prediction models for identifying patients at risk of FN among patients receiving chemotherapy. Several studies presented approaches to symptom management that included fever among the symptoms, but results were not mature enough to merit widespread adoption.
  
  
  CONCLUSIONS
  Despite the frequency and risks of fever in the setting of chemotherapy, there is limited evidence to define who needs urgent assessment, where the assessment should be performed, and how quickly. Future research in this area is greatly needed to inform new models of care.
authors.affiliation: Princess Margaret Cancer Centre, Toronto, ON, Canada; Systemic Treatment Program, Cancer Care Ontario, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: ccopgi@mcmaster.ca.
authors.forename: M K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.affiliation: Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Walker-Dilks
authors.affiliation: University of Toronto, Toronto, ON, Canada; Sinai Health System-University Health Network, Antimicrobial Stewardship Program, Toronto, ON, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Morris
authors.affiliation: Windsor Regional Cancer Program, Windsor, ON, Canada; University of Windsor Schulich School of Medicine and Dentistry, Windsor, ON, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Waterloo Wellington Regional Cancer Program, Grand River Hospital, Kitchener, ON, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Halligan
authors.affiliation: Department of Oncology, McMaster University, Hamilton, ON, Canada; Malignant Hematology, Juravinski Cancer Centre, Hamilton, ON, Canada.
authors.forename: C T
authors.initials: CT
authors.lastname: Kouroukis
authors.affiliation: Windsor Regional Cancer Program, Windsor, ON, Canada; University of Windsor Schulich School of Medicine and Dentistry, Windsor, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: K
authors.initials: K
authors.lastname: McCann
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: C L
authors.initials: CL
authors.lastname: Atzema
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D000970:Antineoplastic Agents / Q000009:adverse effects*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000175:diagnosis; D005334:Fever / Q000139:chemically induced* / Q000175:diagnosis*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D010045:Outpatients; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic
chemical_list: D000970:Antineoplastic Agents
keywords: Cancer; Chemotherapy; Febrile neutropenia; Fever