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

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

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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
Publication statusPublished - Jan 2011

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