Evaluation of the Management and Risk Stratification of Cancer Patients with Febrile Neutropenia

Document Type

Conference Proceeding

Publication Date

3-6-2026

Publication Title

Am J Health Syst Pharm

Keywords

adult, antimicrobial activity, antineoplastic activity, cancer diagnosis, cancer inhibition, cancer patient, complication, conference abstract, controlled study, diagnosis, drug therapy, drug utilization review, electronic health record, emergency ward, febrile neutropenia, fever, hospitalization, human, immunosuppressive treatment, major clinical study, male, malignant neoplasm, observational study, prescribing practice, retrospective study

Abstract

Purpose: Febrile neutropenia is a life-threatening complication of anticancer therapy and is classified as an oncologic emergency by the National Comprehensive Cancer Network (NCCN) and the Infectious Diseases Society of America (IDSA)/American Society of Clinical Oncology (ASCO). Patients receiving anticancer therapy are immunosuppressed, placing them at a high risk for severe infections and mortality. Evidence suggests that timely and appropriate antimicrobial selection is associated with improved outcomes, yet the fast-paced emergency department setting may lead to suboptimal or inappropriate treatment. This study aims to evaluate antimicrobial prescribing patterns for adult cancer patients presenting with febrile neutropenia in the emergency department. Methods: This is a single-center, retrospective, observational medication use evaluation conducted at Henry Ford St. John Hospital. A random sample of 100 adult patients who present to the emergency department with a diagnosis of febrile neutropenia and are actively receiving anticancer therapy between January 1, 2020, to July 31, 2025, will be collected from the electronic health record. Patients who are age ≥18 years old at time of admission, receiving anticancer therapy, with an absolute neutrophil count (ANC) < 500 cells/µL or < 1000 cells/µL with a predicted decline to < 500 within 48 hours, and a documented fever defined as ≥101 °F once or ≥100.4 °F sustained for at least one hour will be included. Patients without a cancer diagnosis, younger than 18 years old, pregnant, or have a hospitalization discharge date within the prior 90 days will be excluded. The primary outcome will be the rate of empiric antimicrobial prescribing consistent with NCCN and IDSA/ASCO guideline recommendations. The secondary outcome will be risk stratification of patients using the Clinical Index of Stable Febrile Neutropenia (CISNE) tool, where a score of < 3 will classify patients as low risk, and a score ≥3 will classify patients as high risk. Continuous data will be summarized using means and standard deviations or medians and interquartile ranges, as appropriate. Categorical variables will be reported as frequencies and percentages.

Volume

83

Issue

Supplement_2

First Page

S810

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