NEW YORK (Reuters Health) – Cancer patients who develop febrile neutropenia after chemotherapy but who are otherwise stable can be treated as outpatients, with no greater risk for complications than those receiving inpatient care, researchers report in the Journal of Clinical Oncology online September 19.

“These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with febrile neutropenia in suitable outpatient settings with appropriate surveillance for unexpected clinical deterioration,” the authors conclude.

Dr. James A. Talcott, with Continuum Cancer Centers of New York, New York, and colleagues note that although febrile neutropenia is usually of short duration and is often treated with hematopoietic factors, patients require sustained broad-spectrum antibiotic. This usually meant hospitalization, but the ability to identify low-risk patients and the availability of simplified antibiotic regimens have made outpatient care an attractive option – as long as it does not increase medical risk.

The team therefore conducted a randomized trial of inpatient versus outpatient management of 117 patients with 121 episodes of febrile neutropenia. The median neutrophil count was 100/microliter and the median duration of neutropenia was 4 days.

The primary outcome of a serious medical complication requiring urgent medical attention occurred in five episodes in the hospital arm (8%) and four in the home arm (9%), a nonsignificant difference (p=0.56), the investigator found.

“Our inability to find evidence of adverse medical consequences from home care, despite an aggressive search for indicators of clinical deterioration, should reassure patients and physicians considering appropriately designed outpatient treatment for low-risk febrile neutropenia,” they comment.

Nonetheless, contrary to expectations, home care did not improve quality-of-life scores, the authors note. They believe this may be due to several factors, such as the short duration of low-risk neutropenia or challenges in receiving IV antibiotics at home.

Still, Dr. Talcott and colleagues conclude, “Given the increasing acceptance of outpatient management of febrile neutropenia, our study may represent the last major effort to rigorously characterize its risk.”

Meanwhile, another paper in the journal by some of the same researchers looks at costs of at-home and in-hospital treatment of febrile neutropenia, based on 35 outpatient and 57 inpatient treatment episodes.

They found that mean total charges were $16,341 for the hospital arm compared to $10,977 for the home treatment arm (p<0.01). On the other hand, “Informal caregivers for both treatment arms reported similar time caring and lost from work.”

Reference:
No Place Like Home? Outpatient Management of Patients With Febrile Neutropenia and Low Risk
J Clin Oncol 2011;29.