Adult Patient Care Plan: Management of the Febrile Neutropenic Cancer Patient on an Outpatient Basis

Invasive infection may complicate the course of neutropenic cancer patients receiving intensive chemotherapy. The rateof complications is related to prognostic factors including the underlying malignant diagnosis, the state of responsivenessof the underlying disease to treatment, the dose-intensity of the cytotoxic therapy, the duration of neutropenia, theperformance status of the patient and comorbid conditions. The pathogens involved are usually the patients’ endogenousmicroflora, and the sites of infection are those anatomic sites colonized with the endogenous microflora. The approachto the febrile neutropenic episode requires a sequence of steps including the recognition of the febrile state (oraltemperature higher than 38°C), the depth and duration of the neutropenia (absolute neutrophil count less than0.5×109/L), the identification of a clinical focus of infection and a potential pathogen, the administration of empirical antibacterialtherapy, and finally, an assessment of the outcome. Management decisions about whether to treat with oralor parenteral antibacterial agents, with a combination or single agent therapy, or as an inpatient or an outpatient can bebased on an assessments of risks of the severity of the patient’s comorbid conditions and the patient’s risk of developingmedical complications that would require inpatient management. The duration of antimicrobial treatment depends onthe recovery from the state of neutropenia and the origin of the infectious process