scholarly journals Substantiation of Multinational Association for Supportive Care in Cancer (MASCC) Score in Risk Assessment of Febrile Neutropenic Patients in Hematological Disorders: A Regional Study from Pakistan

2021 ◽  
Vol 5 (3) ◽  
pp. 99-103
Author(s):  
Qurratul Ain Rizvi ◽  
◽  
Aisha Jamal ◽  
Naveena Fatima ◽  
Munira Borhany ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Supportive Care ◽  
Medical Condition ◽  
Low Risk ◽  
Management Approach ◽  
Medical Conditions ◽  
Hematological Disorders ◽  
Mascc Score ◽  
Neutropenic Patients

Abstract: Background: The incidence of neutropenia in hematological malignancies comprises of huge burden of febrile neutropenia. Multinational Association of Supportive Care in Cancer (MASCC) risk index score is the most widely used model for forecast of complications. Objective: The aim of this study was to determine diagnostic accuracy of MASCC scoring system in febrile neutropenia patients suffering from hematological disorders. Materials & Methods: Patients suffering from hematological disorders and presenting with febrile neutropenia were stratified into low and high risk groups according to MASSC score. The standard score range from 0 to 26 points; score of more than or equals to 21 were considered to be low risk and score of less than 21 was high-risk category. As an in-patient at National Institute of Blood Disease & Bone Marrow Transplantation, they were followed over the course of illness for development of any serious medical condition until resolution of febrile neutropenia. Results: Of 217 patients, serious medical conditions were documented in (63%) of individuals among the high-risk group cohort and (13%) developed serious medical conditions in low-risk cohort. Major disease encountered was acute leukemia (69%). Hypotension 14 (22.2%) and hepatic failure 14 (22.2%) were among the two most common variables of established serious medical condition. The overall sensitivity and specificity of MASCC score was 69.8% and 81.8%, with the positive and negative predictive value of 61.1% and 86.8% respectively. Conclusion: The score has been re-validated in this study and determined its significance in ascertainment of high-risk cohort among febrile neutropenic patients in the current era, thereby helping the physicians to tailor the management approach accordingly. Keywords: MASCC, Febrile neutropenia, Leukemia, Hematological disorders, Cytotoxic chemotherapy.

scholarly journals A questionnaire survey on evaluation for penetration and compliance of the Japanese Guideline on Febrile Neutropenia among hematology-oncology physicians and surgeons

2021 ◽  
Author(s):  
Nobu Akiyama ◽  
Takuho Okamura ◽  
Minoru Yoshida ◽  
Shun-ichi Kimura ◽  
Shingo Yano ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Supportive Care ◽  
Questionnaire Survey ◽  
Primary Treatment ◽  
Beta Lactam ◽  
Clinical Practices ◽  
High Risk Patients ◽  
Mascc Score ◽  
Risk Patients

Abstract Purpose The Japanese Society of Medical Oncology published a guideline (GL) on febrile neutropenia (FN) in 2017. The study’s purpose is to reveal how widely GL penetrated among physicians and surgeons providing chemotherapy. Methods A questionnaire survey was conducted with SurveyMonkey™ for members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed with statistical text-analytics. Result A total of 800 responses were retrieved. Major respondents were experts with more than 10-year experience, physicians 54%, and surgeons 46%. Eighty-seven percent of respondents knew and used GL. Forty-eight percent assessed FN with Multinational Association of Supportive Care in Cancer (MASCC) score “always” or “more than half.” Eighty-one percent chose beta-lactam monotherapy as primary treatment in high-risk patients. Seventy-seven percent did oral antibacterial therapy in low-risk patients ambulatorily. Seventy-eight percent administered primary prophylactic G-CSF (ppG-CSF) in FN frequency ≥ 20% regimen. Fifty-nine percent did ppG-CSF for high-risk patients in FN frequency 10–20% regimen. Ninety-seven percent did not use ppG-CSF in FN frequency < 10% regimen. The medians of complete and complete plus partial compliance rates were 46.4% (range 7.0–92.8) and 77.8% (range 35.4–98.7). The complete compliance rates were less than 30% in seven recommendations, including the MASCC score assessment. Conclusion GL is estimated to be widely utilized, but some recommendations were not followed, presumably due to a mismatch with actual clinical practices in Japan.

scholarly journals TissueCypher Barrett’s esophagus assay impacts clinical decisions in the management of patients with Barrett’s esophagus

2021 ◽  
Vol 09 (03) ◽  
pp. E348-E355
Author(s):  
David L. Diehl ◽  
Harshit S. Khara ◽  
Nasir Akhtar ◽  
Rebecca J. Critchley-Thorne
Keyword(s):  
High Risk ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Clinical Decision Making ◽  
Eradication Therapy ◽  
Low Risk ◽  
Management Approach ◽  
Low Grade ◽  
Management Decisions ◽  
The Impact

Abstract Background and study aims The TissueCypher Barrett’s Esophagus Assay is a novel tissue biomarker test, and has been validated to predict progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in patients with Barrett’s esophagus (BE). The aim of this study was to evaluate the impact of TissueCypher on clinical decision-making in the management of BE. Patients and methods TissueCypher was ordered for 60 patients with non-dysplastic (ND, n = 18) BE, indefinite for dysplasia (IND, n = 25), and low-grade dysplasia (LGD, n = 17). TissueCypher reports a risk class (low, intermediate or high) for progression to HGD or EAC within 5 years. The impact of the test results on BE management decisions was assessed. Results Fifty-two of 60 patients were male, mean age 65.2 ± 11.8, and 43 of 60 had long segment BE. TissueCypher results impacted 55.0 % of management decisions. In 21.7 % of patients, the test upstaged the management approach, resulting in endoscopic eradication therapy (EET) or shorter surveillance interval. The test downstaged the management approach in 33.4 % of patients, leading to surveillance rather than EET. In the subset of patients whose management plan was changed, upstaging was associated with a high-risk TissueCypher result, and downstaging was associated with a low-risk result (P < 0.0001). Conclusions TissueCypher was used as an adjunct to support a surveillance-only approach in 33.4 % of patients. Upstaging occurred in 21.7 % of patients, leading to therapeutic intervention or increased surveillance. These results indicate that the TissueCypher test may enable physicians to target EET for TissueCypher high-risk BE patients, while reducing unnecessary procedures in TissueCypher low-risk patients.

Predicting febrile neutropenic patients at low risk using the MASCC score: does bacteremia matter?

2010 ◽  
Vol 19 (7) ◽  
pp. 1001-1008 ◽  
Author(s):  
Marianne Paesmans ◽  
Jean Klastersky ◽  
Johan Maertens ◽  
Aspasia Georgala ◽  
Frédérique Muanza ◽  
...  
Keyword(s):  
Low Risk ◽  
Mascc Score ◽  
Neutropenic Patients

scholarly journals Multiple Myeloma, Clinical Characteristics, and Increased COVID-19 Risk Using Real-World Data

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3778-3778
Author(s):  
Emily I. Liu ◽  
Nathan W. Sweeney ◽  
Jennifer M. Ahlstrom
Keyword(s):  
At Risk ◽  
Multiple Myeloma ◽  
High Risk ◽  
Clinical Characteristics ◽  
Medical Condition ◽  
Severe Case ◽  
High Risk Group ◽  
Smoking History ◽  
Medical Conditions ◽  
Real World Data

Abstract Background: A question that was commonly investigated during the COVID-19 pandemic was which clinical characteristics would make one more susceptible to contracting COVID-19? This was especially a concern for those who were considered "high risk" as they would be more prone to suffering from more severe COVID-19 symptoms and at times even death. In this abstract, we investigated which clinical characteristics of multiple myeloma (MM) cancer patients could make them more prone to contracting COVID-19. We also investigated which of these conditions make patients more at risk for experiencing more severe COVID-19 symptoms (PMID: 32950467, PMID: 32353254). Knowing what medical conditions that would make a patient more at risk for contracting or experiencing a more severe case of COVID-19 has been a concern for many, especially for those who suffer from more severe health conditions such as cancer. Methods: MM patient data and demographics were collected through HealthTree ® Cure Hub for Multiple Myeloma. We analyzed medical conditions including hypertension, heart condition, neuropathy condition, and BMI. We also looked into lung condition, kidney condition, diabetes, stroke, smoking history, drug use history, HIV, and Mediterranean descent but did not include in the figure due to small population sizes. We determined whether a patient had to be hospitalized, admitted to the ICU, needed oxygen therapy, or needed a D-dimer test as a severe COVID-19 case. Multivariable logistic regressions were performed to quantify the risk for contracting COVID-19 for patients with specific medical conditions and which medical conditions made COVID-19 positive patients more at risk for experiencing a more severe case of COVID-19. Results: Out of the 962 patients that were involved in this study, we found that patients who were overweight were 2% more likely to contract COVID-19 than those who were not overweight. Other medical conditions did not increase the risk of contracting COVID-19. Furthermore, there were 35 patients that were involved in investigating how certain medical conditions may affect the severity of COVID-19 symptoms. We found that overweight patients were 12% more likely to suffer from more severe COVID-19 than those not overweight. Patients who suffered from neuropathy conditions were 3% more likely to experience a more severe COVID-19 case than those who do not have that condition. It is important to note that these results were not statistically significant, although are still informative. Conclusion: Our results show that MM patients who are overweight have a greater tendency to not only contract COVID-19 but experience a more severe case of COVID-19. Somewhat surprisingly, we found that patients who experience neuropathy, common among MM patients, had a higher tendency to experience a more severe case of COVID-19. We speculate whether MM patients, a high-risk group due to their immunocompromised state, took extra care to follow safety recommendations and caution to avoid contracting COVID-19. A logical next step would be to compare medical condition interactions to examine whether patients with more than one condition experience additive or synergistic risk, as well as comparing out results to other high-risk groups. These findings, although not statistically significant, may help MM patients identify which of their own medical conditions may put them more at risk for contracting COVID-19 and thus take precautionary measures. Figure 1 Figure 1. Disclosures Ahlstrom: Takeda: Other: Patient Advisory; Pfizer: Other: Patient Advisory; Janssen: Other: Patient Advisory; Bristol Myers Squibb: Other: Patient Advisory.

Outpatient Treatment with Intravenous Antimicrobial Therapy in Patients with Febrile Neutropenia and Hematologic Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4717-4717
Author(s):  
Marcelo Bellesso ◽  
Luis Fernando Pracchia ◽  
Lucia Dias ◽  
Dalton Chamone ◽  
Pedro Dorlhiac-Llacer
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Serum Creatinine ◽  
Pulse Oximetry ◽  
Antimicrobial Therapy ◽  
Outpatient Treatment ◽  
Laboratory Data ◽  
Hematologic Malignancies ◽  
Initial Therapy ◽  
Low Risk

Abstract OBJECTIVES: The purpose of this study is to evaluate outcomes like success of the initial therapy; failure of outpatient treatment and death in outpatient treatment with intravenous antimicrobial therapy in patients with febrile neutropenia (FN) and hematologic malignancies. In addition, it was compared clinics, laboratory data and Multinational Association for Supportive Care of Cancer index (MASCC) with failure of outpatient treatment and death. PATIENTS AND METHODS: In a retrospective study we evaluated FN following chemotherapy events that were treated initially with Cefepime, with or without Teicoplanin. RESULTS: Of the 178 FN episodes in 128 patients, it was observed success of initial therapy in 63.5% events, failure of outpatient treatment in 20.8% and death in 6.2%. In multivariate analysis, significant risks of failure of outpatient treatment were smoking (OR: 3.14, IC: 1.14 – 8.66, p=0.027) and serum creatinine &gt; 1.2mg/dL (OR: 7.97, IC: 2.19 – 28.95, p = 0.002). About death, the risk was pulse oximetry &lt; 95% (OR: 5.8, IC: 1.50 – 22.56, p = 0.011). Analyzing MASCC index, 165 events were classified as low risk and 13 as high-risk. Failure of outpatient treatment were reported in connection with 7 (53.8%) high-risk episodes and 30 (18.2%) low-risk, p=0.006. In addition, death in 7 (4.2%) lowrisk and 4 (30.8%) high-risk events, p=0.004. CONCLUSIONS: The outpatient treatment with intravenous antibiotic was satisfactory. The risks: smoking, serum creatinine elevated and pulse oximetry should be considered in FN evaluation. It was validated MASCC index in Brazilian population.

Differences In Community and Academic Practice Patterns For Newly Diagnosed Myelodysplastic Syndromes (MDS) Patients In Minnesota: A Population Based Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2798-2798 ◽  
Author(s):  
Daniel Pease ◽  
Julie A Ross ◽  
Phuong L. Nguyen ◽  
Betsy Hirsch ◽  
Adina Cioc ◽  
...  
Keyword(s):  
High Risk ◽  
Supportive Care ◽  
Practice Patterns ◽  
Risk Group ◽  
Population Based ◽  
Low Risk ◽  
Risk Scores ◽  
First Year ◽  
Newly Diagnosed ◽  
Population Based Study

Abstract Introduction Expanding treatment options for MDS have changed therapeutic decision-making for clinicians. To better characterize therapeutic choices in newly diagnosed MDS, we report the practice patterns captured during the first year of MDS diagnosis for patients enrolled in our statewide population-based study. We highlight a comparison of treatment in community and academic centers. Methods Adults in Minnesota with MDS (AIMMS) is a statewide prospective population-based study conducted by the University of Minnesota (UMN), Mayo Clinic, and Minnesota Department of Health. Starting in April 2010, all newly diagnosed adult cases (ages 20+) of MDS were invited to participate. After patient enrollment, central review was performed consisting of independent hematopathology and cytogenetic review coupled with oncologist chart review assigning prognostic risk scores [International Prognostic Scoring System (IPSS) and IPSS-R (Revised)] and abstracting treatment exposures. All enrolled patients with one year follow-up were included in this analysis. Treatment was divided into supportive, active, transplant, or other. Supportive care included observation, growth factors, and transfusions. Active care included azacitidine, decitabine, lenalidomide, or 7+3 chemotherapy. Academic centers were defined as the UMN and Mayo Clinic; all other centers were designated as community based practices. Results The median patient age was 73 years, with 68% males. IPSS and IPSS-R risk scores were calculated for 100% and 97% of patients, respectively. Treatment choices stratified by IPSS risk group showed 89% low risk, 53% INT-1, 31% INT-2, and 13% high risk with supportive care; active and transplant strategies were utilized for 9% low risk, 44% INT-1, 64% INT-2, and 88% high risk. INT-1 in the community received 70% supportive treatment, in academic 35%. Active treatment for INT-1 was 30% in community and 45% in academic. Community INT-2 received supportive care in 45% of cases, in academic 23%. Transplants were limited to academic centers, with the highest rate in INT-2 at 34%. Among community diagnoses, 100% of high risk, 52% INT-2, 26% INT-1, and 13% low risk were referred to an academic center. Comparison of age <65 and 65+ years showed 83% of transplants occurred in those <65. INT-2/high risk group patients <65 received 95% active therapy or transplant, compared to 51% of those 65+. Discussion This prospective, population based study provides a well-defined patient cohort based on central review of pathologic and clinical data. Evaluation of practice patterns during the first year after diagnosis showed higher utilization of active and transplant treatment strategies as IPSS risk score increased. Further, compared to community, higher utilization occurred for patients at academic centers, suggesting more aggressive treatment in these settings. Age was also a predictor of treatment choice. In addition, referral patterns followed IPSS score. Whether these treatment differences are driven by patient preference and/or translate into improved disease control and decreased mortality requires continued prospective analysis and will be detailed in future reports. Disclosures No relevant conflicts of interest to declare.

Is It Time for Early Cessation of Empirical Antibiotherapy in Patients Presenting with Febrile Neutropenia? Preliminary Results of a Risk-Adapted Approach in a Hematology Clinic

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2503-2503
Author(s):  
Ali Hakan Kaya ◽  
Emre Tekgunduz ◽  
Filiz Bekdemir ◽  
Hikmetullah Batgi ◽  
Tugcenur Yigenoglu ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Clinical Characteristics ◽  
Cost Effective ◽  
High Risk Group ◽  
Risk Category ◽  
Study Cohort ◽  
Preliminary Results ◽  
Mascc Score ◽  
Infectious Focus ◽  
Neutropenic Patients

Abstract Introduction : Febrile neutropenia (FN) is an important cause of mortality in hematology practice. Prompt recognition and treatment of FN is crucial to prevent development of sepsis and subsequent mortality. The duration of empirical antibiotherapy in hemodynamically stabile, afebrile, culture negative patients without an infectious focus is a controversial issue. Recently published guidelines encourage the use of early cessation of empirical antibiotherapy in these patients. Here we report our preliminary experience of early discontinuance of empirical antibiotherapy in febrile neutropenic patients who were treated with a risk-adapted strategy. Methods: All consecutive patients who were treated during June 2014-April 2016 period and presented with FN were included. Demographic and clinical data of patient cohort was prospectively collected within the context of institutional FN registry and analyzed retrospectively. Previously established standard criteria are used to diagnose FN episodes. MASCC score defined the risk category of patients. A new FN episode was considered when FN re-occurred in a patient who remained afebrile for at least 72 hours after discontinuation of antibiotics. All patients were treated within the framework of a written, institutional FN guideline, which is in line with EGIL-4 (European Conference on Infections in Leukemia) recommendations. Empirical antibiotherapy was stopped in patients, who were hemodynamically stabile, had no infectious focus, had negative culture results, received broad-spectrum empiric antibiotherapy for 3 days and were afebrile for at least 2 days. Results: The study included a total of 137 patients (87 males-50 females). Median age of patients was 49 (16-87). All patients were in high-risk group according to MASSC criteria. Demographic and clinical features of the study cohort are summarized in Table-1. During the study period 249 FN episodes were evaluated. Empirical antibiotherapy was discontinued in 47 (18,9%) FN episodes in 44 (32,1%) patients. Following cessation of empirical antibiotherapy, 11 (23,4%) new FN episodes developed and no patient infection-related deaths in the following 100 days. Discussion: Our preliminary results indicate that cessation of empirical antibiotherapy in a strictly defined patient population with FN seems to be feasible. We were able to stop antibiotherapy in 18,9% of patients and 76,6% of them did not experience a new FN episode. This strategy is cost-effective and seems to be quite safe, as we did not observed any infection-related deaths in the first 100 days following discontinuation of antibiotherapy. These patients were also protected from possible side effects of unnecessary antibiotics. Future studies will define the role of this provocative approach and may change the way we treat febrile neutropenic patients. Table Demographic and clinical characteristics of patients Table. Demographic and clinical characteristics of patients Disclosures Demirkan: Amgen: Consultancy.

Rater

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20678-e20678
Author(s):  
B. Rangarajan ◽  
K. Prabhash ◽  
R. Nair ◽  
H. Menon ◽  
P. Jain ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Predictive Value ◽  
Risk Index ◽  
Febrile Episode ◽  
Index Score ◽  
Low Risk ◽  
Mascc Score ◽  
Sensitivity Specificity ◽  
Risk Index Score

e20678 Background: Management of neutropenic fever is based on risk stratification of the episode which helps in optimizing treatment. MASCC is the most commonly used for risk stratification Patients with a score of > 21 were regarded as low risk; patients with a score of <21 were regarded as high risk. We tried to validate the MASCC index for our ethnic population. Methods: Patients were recruited throughout a 12 month period. Inclusion criteria were diagnosis of hematolymphoid malignancy, neutropenic febrile episode secondary to chemotherapy or during induction therapy of acute leukemia and more than 18 years of age All patients were risk stratified, hospitalized and treated with broad-spectrum, empiric, intravenous antibiotic therapy until recovery or outcome of the event. The incidence of medical complications in both groups and death related to the neutropenic infection was recorded. The data was entered on SPSS software and MASCC criteria was analyzed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: A total of 81 febrile neutropenic episodes were included; 34 classified as low risk and 47 as high risk according to MASCC risk index score. The sensitivity, specificity, PPV, NPV and accuracy of MASCC risk index score were 45.5%, 40%, 11%, 82%, 40.7%. We subsequently analyzed the subset of Acute Myeloid Leukemia (AML) patients as they were the majority comprising of 62/81 episodes. The subset of AML patients risk stratified according to MASCC risk index showed sensitivity, specificity, PPV, NPV and accuracy of 71%, 25.5%, 11%, 87.5%, 31% respectively. Conclusions: In our patient group, the value of MASCC score is limited with poor sensitivity, specificity and PPV. This trend is also seen in the subset analysis of AML patients. The value of the MASCC index with the score of 21 as the cut-off between low risk and high risk seems limited in our patients and requires confirmation with larger set of patients. No significant financial relationships to disclose.

Assessing the impact of a targeted electronic medical record intervention on growth factor usage in cancer patients.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 262-262
Author(s):  
Jordan Bernens ◽  
Kara Hartman ◽  
Brendan F. Curley ◽  
Sijin Wen ◽  
Jame Abraham ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Low Risk ◽  
Individual Risk ◽  
Individual Risk Factors ◽  
The Impact

262 Background: Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. Prophylactic growth factors (G-CSF) should be in patients receiving high-risk regimens or intermediate-risk regimens with individual risk factors. The impact of electronic medical record system (EMR) implementation on compliance with G-CSF support guidelines has not been studied. Methods: At West Virginia University/Mary Babb Randolph Cancer Center we conducted an IRB approved retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR). We reviewed the chemotherapy regimens and patient risk factors for developing febrile neutropenia, and determined if the G-CSF usage was consistent with guideline recommendations. Results: Compliance with prophylactic G-CSF guidelines was 75.6% in the post-EMR arm, compared to 67.5% in the pre-EMR arm (p=0.041, ch-square). The post EMR data of 1,042 new chemotherapy initiations showed: (see Table). The appropriateness of usage in high and low risk patients were the most compliant, as G-CSF orders were built into chemotherapy plans of high risk regimens and omitted from low risk regimens. Conclusions: Appropriate prophylactic G-CSF usage can be improved when orders are integrated into standard chemotherapy order sets in an EMR. An area of further improvement would include automatic identification of individual risk factors by the EMR. [Table: see text]

scholarly journals Ambulatory Outpatient Management of patients with low risk febrile neutropaenia

2015 ◽  
Vol 14 (4) ◽  
pp. 178-181
Author(s):  
Timothy Cooksley ◽  
◽  
Mark Holland ◽  
Jean Klastersky ◽  
◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Cost Savings ◽  
Scoring Systems ◽  
Low Risk ◽  
Ambulatory Setting ◽  
Medical Complications ◽  
Mascc Score ◽  
Risk Patients ◽  
Reduced Risk ◽  
Avoidance Cost

Patients with febrile neutropenia are a heterogeneous group with only a minority developing significant medical complications. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score, have been developed and validated to identify low risk patients. Caring for patients with low risk febrile neutropenia in an ambulatory setting is proven to be safe and effective. Benefits include admission avoidance, cost savings and reduced risk of nosocomial infections, as well as improved patient experience and satisfaction. Implementation of an ambulatory pathway for low risk febrile neutropenia provides an excellent opportunity for Acute Physicians and Oncologists to collaborate in delivering care for this group of patients.

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