BackgroundFebrile neutropenia is an oncologic emergency. The timing of antibiotics administration in patients with febrile neutropenia may result in adverse outcomes. Our study aims to determine time-to- antibiotic administration in patients with febrile neutropenia, and its relationship with length of hospital stay, intensive care unit monitoring, and hospital mortality.MethodsThe study population was comprised of adult cancer patients with febrile neutropenia who were hospitalized, at a tertiary care hospital, between January 2010 and December 2011. Using Multination Association of Supportive Care in Cancer (MASCC) risk score, the study cohort was divided into high and low risk groups. A multivariate regression analysis was performed to assess relationship between time-to- antibiotic administration and various outcome variables.ResultsOne hundred and five eligible patients with median age of 60 years (range: 18–89) and M:F of 43:62 were identified. Thirty-seven (35%) patients were in MASCC high risk group. Median time-to- antibiotic administration was 2.5 hrs (range: 0.03-50) and median length of hospital stay was 6 days (range: 1–57). In the multivariate analysis time-to- antibiotic administration (regression coefficient [RC]: 0.31 days [95% CI: 0.13-0.48]), known source of fever (RC: 4.1 days [95% CI: 0.76-7.5]), and MASCC high risk group (RC: 4 days [95% CI: 1.1-7.0]) were significantly correlated with longer hospital stay. Of 105 patients, 5 (4.7%) died & or required ICU monitoring. In multivariate analysis no variables significantly correlated with mortality or ICU monitoring.ConclusionsOur study revealed that delay in antibiotics administration has been associated with a longer hospital stay.

456 Background: Currently there is very low quality evidence available regarding survival benefit of SRPT in patients with mCRC. In the absence of randomization the reported benefit may reflect selection of younger and healthier patients with good performance status (PS). We have undertaken a retrospective cohort study to determine the survival benefit of SRPT in mCRC. Methods: A cohort of 1,378 patients with mCRC diagnosed between 1992-2005 in the province of Saskatchewan was evaluated. Kaplan-Meier curves were used to determine survival. Log-Rank test was done to compare survival between the two groups. Cox regression model was used to adjust survival for important prognostic variables. Results: Median age was 70 yrs (22-98) and M:F was 57:43. 27% had ECOG PS of >1 and 62% had a comorbid illness. 944 (69%) patients underwent SRPT. Among 1,378 patients, 40% were operated for tumor related symptoms (33% obstruction, 6% perforation, and 4% heavy bleeding, mutually nonexclusive). Median follow up time for whole cohort was 7.1 months (inter-quartile range 2.5-17.5). 42.3% received chemotherapy and 19.1% received 2nd generation therapy. Median survival of patients who received chemotherapy was 15.9 months. Patients who underwent SRPT had median overall survival of 18.3 months vs. 8.4 months if they did not have surgery (p<0.0001).On multivariate analysis 5FU-based chemotherapy (HR 0.53; 95%CI: 0.45-0.61), metastesectomy (HR 0.54; 95%CI: 0.45-0.64), SRPT (HR 0.55; 95%CI: 0.48-0.62), and 2nd generation chemotherapy (HR 0.65; 95%CI: 0.54-0.77) were correlated with a better survival whereas, elevated CEA level (1.56; 95%CI: 1.30-1.90), leukocytosis (HR 1.54; 95%CI: 1.33-1.80), ECOG PS >1 (HR 1.48; 95%CI: 1.30-1.69), low albumin (HR 1.44; 95%CI: 1.26-1.64), age ≥ 65 yrs (HR 1.21; 95%CI: 1.10-1.38), anemia (HR 1.16; 95%CI: 1.03-1.31), and symptomatic disease (HR 1.12; 95%CI: 1.0-1.26) were correlated with poor survival. Comorbid illness, smoking, and gender did not correlate with survival. Conclusions: This is the first large cohort study that reveals that SRPT in patients with mCRC improves survival independent of chemotherapy, age, functional status and comorbid illness.