Outpatient management of chemotherapy induced neutropenia – pro
Outpatient management is the standard care for lymphoma patients receiving chemotherapy, who usually have a <50% risk of developing fever. Outpatient management with oral antibiotics is increasingly common for so-called low-risk febrile neutropenia. Outpatient management has now also become a common mode of care for selected patients undergoing autoPBSCT and even alloPBSCT despite their increased risks of toxicity including infectious complications. There is published experience from several groups and different locations to suggest that carefully designed outpatient autoPBSCT programmes can be successful. What are the successes? Reduced inpatient care could reduce health-care costs, prevent family disruption caused by prolonged hospitalisation and raise patients’ quality of life. In theory, less exposure to nosocomial pathogens might have additional favourable effects. However, this is not well documented, and exposure to certain pathogens such as respiratory viruses and moulds might rather be increased in the home environment compared with the hospital environment. Most centres have an early discharge and outpatient management programme, rather than a comprehensive outpatient management programme. Despite the need for readmission in a significant proportion of discharged patients (mostly due to fever, fatigue, mucositis/dehydration), the length of stay can be significantly reduced, and this reduces costs.
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