Safety of outpatient management of cancer patients at risk of neutropenic sepsis using MASCC score at the Norfolk and Norwich University Hospital


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Ahmed Eltinay1,Gill Gray1,Ricky Fenn1,Saif Ahmad1
1Norfolk and Norwich University Hospital

Abstract

Background

Neutropenic sepsis (NS) is a potentially fatal complication of chemotherapy. Patients with febrile neutropenia or neutropenia with other infective symptoms are at risk of NS. The MASCC score (Multinational Association for Supportive Care in Cancer) stratifies potential NS patients as low (≥21) or high-risk (<21) and has NICE approval. Patients at low-risk may not require admission.   

Method

This study evaluated the use of MASCC score in the management of NS at Norfolk and Norwich University Hospital. Patients with favourable clinical and social circumstances and a low-risk MASCC score were discharged with oral antibiotics. An electronic register was used to study all emergency presentations of possible NS between April 2016 and April 2018 to Acute Oncology (AOS), Medical Admissions (MAU) and A&E. 

Results

In total, 242 patients presented with potential NS. 170 attended AOS and 72 attended MAU/A&E. The most common primary tumours were breast (64%), lung (13%) and prostate (9.6%). The most common regimens were carboplatin and docetaxel (72%) and FEC (17%).

 

Among AOS attendees 83 patients (49%) were discharged, all of whom had a low-risk MASCC score. Within these 83 patients, median age was 60, and 64 patients (77%) were female. 11 patients (13%) post-discharge were re-admitted within a week; none of these patients died or were admitted for more than one week. Significantly, those patients who were re-admitted had a lower MASCC score at the time of assessment (22 vs 24; p=0.0028). Among non-AOS attendees, only 2 patients (2.7%) were not admitted suggesting that early discharge using MASCC score had not yet been adopted outside of AOS.  

Conclusion

MASCC score accurately identifies patients at risk of NS who can be safely managed at home. Re-admission of these patients is more likely if the absolute MASCC score nears 21 and this should inform counseling and follow-up in this patient group.