An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009

S Lingaratnam, M Slavin, L Mileshkin, B Solomon, K Burbury, J Seymour, R Sharma, Bogda Koczwara, S Kirsa, I Davis, M Prince, J Szer, C Underhill, O Morrissey, K Thursky

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    Abstract

    Background: An abundance of new evidence regarding treatment strategies for neutropenic fever is likely to contribute to variability in practice across institutions and clinicians alike. Aims: To describe current clinical practices in Australia, by surveying haematologists, oncologists and infectious diseases physicians involved in cancer care. Methods: Clinician members from Australian professional associations, accounting for the vast majority of Australian cancer specialists, were invited to participate in an electronic survey, comprising of a clinical case-based questionnaire. Clinical practice areas explored were: use of risk-assessment and empiric antibiotic strategies across various treatment settings; use of anti-bacterial prophylaxis; and use of granulocyte-colony stimulating factors for established neutropenic fever and for secondary prophylaxis. Results: A total of 252 clinicians returned responses (approximately 30% response rate). The majority (>70%) were representative of practices in public, major city, tertiary referral hospitals. Less than half of clinicians were aware of risk-assessment tools and less than quarter currently used ambulatory care strategies. If adequate resources were made available, more than 80% were willing to use risk-assessment tools and 60% more clinicians were likely to use ambulatory care strategies. Most clinicians prescribed dual therapy parenteral antibiotics, even for clinically stable patients (53% haematologists, 56% oncologists). Granulocyte-colony stimulating factor was used frequently as secondary prophylaxis in the breast cancer case (91%), follicular lymphoma case (59%) and non-small cell lung cancer case (31%). Fluoroquinolone prophylaxis was infrequently prescribed (19% oncologists, 30% haematologists). Conclusions: Evidence-practice gaps were identified around the use of risk-assessment-based empiric therapy, and help to inform better clinical guidance.

    Original languageEnglish
    Pages (from-to)110-120
    Number of pages11
    JournalInternal Medicine Journal
    Volume41
    Issue number1 B
    DOIs
    Publication statusPublished - Jan 2011

    Keywords

    • Ambulatory care
    • Antibiotics
    • Clinical practice survey
    • Neutropenic fever

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    Lingaratnam, S., Slavin, M., Mileshkin, L., Solomon, B., Burbury, K., Seymour, J., Sharma, R., Koczwara, B., Kirsa, S., Davis, I., Prince, M., Szer, J., Underhill, C., Morrissey, O., & Thursky, K. (2011). An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009. Internal Medicine Journal, 41(1 B), 110-120. https://doi.org/10.1111/j.1445-5994.2010.02342.x