Low-Risk Febrile Neutropenia Management: An Audit of Practice in a UK Cancer Center

Abstract

Background

Febrile neutropenia (FN) is a known complication of chemotherapy. Guidelines from American Society of Clinical Oncology and National Institute for Health and Care Excellence support outpatient management for low-risk FN patients; however, implementation varies across United Kingdom (UK) cancer centers. While some centers have adopted outpatient pathways, others continue to rely on inpatient care, leading to inequities in FN management. Standardized use of risk stratification tools, such as the Multinational Association of Supportive Care in Cancer (MASCC) and Clinical Index of Stable Febrile Neutropenia (CISNE) scores, is essential for equitable FN management. Globally, oncology nurses play a critical role in optimizing FN care to reduce hospital admissions in low-risk patients.

Objectives

This retrospective study aimed to determine the proportion of FN patients classified as low risk using the MASCC and CISNE scores, evaluate their clinical outcomes, and assess the feasibility of outpatient management.

Methods

A retrospective audit of adult patients with solid tumors admitted with FN was conducted at a UK NHS cancer center over a 6-month period. Data on MASCC/CISNE scores, clinical outcomes, length of stay, and antibiotic use were extracted from electronic records. Statistical analyses, including Mann–Whitney U and Kruskal–Wallis tests, were performed. A cost analysis estimated potential financial savings from outpatient management.

Results

Of 18 FN admissions, 11 (61.1%) were classified as low risk by MASCC, and 6 (54.5%) of these were also low risk by CISNE. No adverse events were observed. The median length of stay was shorter for MASCC low-risk patients v high-risk patients (6 v 8 days, P = .043). Estimated cost savings were approximately £30,000 over 6 months. Some UK centers have successfully implemented outpatient FN pathways, but variation in risk stratification and systemic inequities exist.

Conclusions

Oncology nurses are key to standardizing FN risk assessment and advocating for equitable outpatient FN care. Addressing disparities in low-risk FN management may optimize healthcare resources and improve patient experience.