Systematic review of reduced therapy regimens for children with low risk febrile neutropenia

Abstract

Reduced intensity therapy for specified groups is safe with low rates of treatment failure. Services should consider how these can be acceptably implemented.

Predicting Infectious ComplicatioNs in Children with Cancer: an external validation study

“…There were no infection relapses or deaths and only two episodes required ICU admission, both of which occurred within the first 9 h of presentation. Although the impact of hospital admission and IV antibiotics in the prevention of these serious outcomes remains unknown, this low rate is in keeping with studies of oral and outpatient antibiotic management of FN (Morgan et al , 2016). At D2, 11 (33.3%) of the MDI in the low-risk group were known including the three serious Gram-negative bacteraemia episodes.…”

“…In the absence of a low-risk pathway at our centre, these patients remain in hospital for a median of 3.5 days. With increasing evidence that discharge, as early as 24 h, is safe and feasible, these data also provide an estimate of the potential for reductions in in-patient hospital expenditure of up to AUD 2183 per day following implementation of a formal low-risk pathway (Morgan et al , 2016). …”

Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice

“…These data suggest that, with structured low‐risk programmes incorporating risk assessment, regular observation and appropriate safeguards, many more low‐risk patients would benefit from reduced‐intensity home‐based care. Such treatment has been shown to be safe, improve quality of life and is significantly less expensive than routine inpatient care …”

Towards evidence based medicine for paediatricians

“…In some areas (like the flashy but unhelpful video-assisted-intubation devices used in children1), such trials exist. In other areas, we have non-randomised comparative data, and in others we may have single-arm studies showing that the ‘reduced’ approach leads to acceptably small levels of problems (eg, in low-intensity treatment of febrile neutropenia2). As with other interventional evidence, we need to weigh the possible biases and errors against the advantages and disadvantages of the management undertaken, and remember that side effects can be just as dangerous as disease effects 3…”