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An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009
Author(s) -
Lingaratnam S.,
Slavin M. A.,
Mileshkin L.,
Solomon B.,
Burbury K.,
Seymour J. F.,
Sharma R.,
Koczwara B.,
Kirsa S. W.,
Davis I. D.,
Prince M.,
Szer J.,
Underhill C.,
Morrissey O.,
Thursky K. A.
Publication year - 2011
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2010.02342.x
Subject(s) - medicine , intensive care medicine , febrile neutropenia , empiric therapy , referral , ambulatory , neutropenia , family medicine , alternative medicine , chemotherapy , pathology
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.