Compare the prophylactic use of Pegfilgrastim, as of the first CT cycle, against the use of medical criteria to manage the occurrence of FN(1313 Flores QI, Ershler W. Managing Neutropenia in Older Patients With Cancer Receiving Chemotherapy in a Community Setting. Clin J Oncol Nurs[Internet]. 2010[cited 2015 Oct 21];14(1)81-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20118030
http://www.ncbi.nlm.nih.gov/pubmed/20118...
)
|
A reduction was observed in the occurrence of NF amounting to approximately 60% with the prophylactic use of Pegfilgrastim since the beginning of the CT cycle in elderly patients and a reduction by approximately 50% when used according to medical criterion |
Prophylactic use of Pegfilgrastim in elderly patients was shown to be efficient in avoiding the reduction of CT doses and CT cycle delays. It favors the reduction of complications due to NF, reducing the number of prolonged hospitalizations and use of ABT. Nurses can contribute to the identification of elderly patients who would benefit from the proposed intervention. |
To recommend home treatment for low-risk NF patients in order to reduce hospital costs(1414 Talcott JA, Yeap BY, Clark JA, Siegel RD, Madeireiros ET, Lu C, et al. Safety of early discharge for low-risk patients with febrile neutropenia: a multicenter randomized controlled trial. J Clin Oncol[Internet]. 2011 [cited 2015 Oct 21];20;29(30):3977-83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21931024
http://www.ncbi.nlm.nih.gov/pubmed/21931...
). |
Early hospital discharge for low-risk FN patients, with ambulatory follow-up and/or supervision contributes to a reduction in hospital costs and improves the quality of life for patients. |
Promoting early hospital discharge of low-risk FN patients, with appropriate ABT and ambulatory follow-up and/or supervision, attenuates the occurrence of complications and reduces hospital costs. |
Evaluate the pharmacokinetics of administering piperacillin/tazobactam in patients with hematologic neoplasms and FN after CT(1515 Álvarez JC, Cuervo SI , Garzón JR , Gómez JC , Díaz JA , Silva E , et al. Pharmacokinetics of piperacillin/tazobactam in cancer patients with hematological malignancies and febrile neutropenia after chemotherapy. BMC Pharmacol Toxicol[Internet]. 2013[cited 2015 Oct 21];14:59. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24286231
http://www.ncbi.nlm.nih.gov/pubmed/24286...
). |
Demonstrated improved efficacy of piperacillin/tazobactam, for the treatment of FN, when initiated after CT. |
FN patients medicated with piperacillin/tazobactam, after realizing CT, present more favorable pharmacokinetic variations for the prevention of FN complications. |
Analyze administration of growth factor as a prophylaxis against FN(1616 Bravo SB, Peña EGH, Sánchez RG, Durán PA, Sánchez Fresneda MNS, Sáez MS. Análisis descriptivo de los motivos que originan visitas a urgencias en pacientes oncológicos: toxicidad postquimioterapia. Farm Hosp[Internet]. 2015[cited 2016 Apr 02];39(6):333-7. Available from: http://dx.doi.org/10.7399/fh.2015.39.6.8728
http://dx.doi.org/10.7399/fh.2015.39.6.8...
). |
The use of growth factor reduced the occurrence of CT-induced FN. |
It was concluded that use of growth factor in patients submitted to CT prevents the occurrence of FN. |
Evaluate the association of the C-reactive protein value with the MASCC risk index for the identification of high-risk FN patients(1717 Juan F, Lombana M, Pino LE, Arango M. C-reactive protein and the MASCC risk index identify high-risk patients with febrile neutropenia and hematologic neoplasms. Support Care Cancer[Internet]. 2015[cited 2015 Oct 21];23(4):1009-13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25270848
http://www.ncbi.nlm.nih.gov/pubmed/25270...
). |
The combination of results from the MASCC risk index and C-reactive protein value during the first five days of an FN episode allows the high-risk patient group to be identified. |
Association of the C-reactive protein analysis and MASCC risk index score favors greater accuracy in the diagnosis of high-risk NF patients. |
To analyze the effects of prophylactic administration of growth factor, from the first cycle of CT, in patients with breast cancer and lymphomas(1818 Jolis L, Carabantes F, Pernas S, Cantos B, López A, Torres P, et al. Incidence of chemotherapy-induced neutropenia and current practice of prophylaxis with granulocyte colony-stimulating factors in cancer patients in Spain: a prospective, observational study. Eur J Cancer Care [Internet]. 2013 [cited 2015 Oct 21];22(4):513-21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23730920
http://www.ncbi.nlm.nih.gov/pubmed/23730...
). |
Patients with breast cancer and lymphomas who received prophylactic growth factor presented a reduction in the interruption of chemotherapy treatment due to FN. |
Findings showed the majority of high-risk or moderate-risk NF patients who received growth factor in the 1st cycle of CT presented less treatment delay. |
Realize the collection of procalcitonin (PCT) associated with application of the MASCC risk index in patients with a score ≥ 21 in order to prevent the occurrence of bacteremia and septic shock(1919 Ahn S, Lee YS, Lim KS,Lee JL. Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia. Support Care Cancer[Internet]. 2013[cited 2015 Oct 21];21(8):2303-08. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23519568
http://www.ncbi.nlm.nih.gov/pubmed/23519...
). |
The use of PCT as an adjunct biomarker together with the MASCC risk index score could improve the risk stratification of patients with CT-induced NF. |
The association of PCT and results of the MASC risk index favors an improved risk stratification for NF patients. |
Prophylactic use of granulocyte colony-stimulating factor (G-CSF) for CT patients in order to prevent the occurrence of FN(2020 Puccini LRB, Koyalchujk S, Fabbri E, Bonizzoni E, Perrone T, Bosi A. Feasibility and safety of a reduced duration of therapy of colony-stimulating factor in a dose-dense regimen. Support Care Cancer[Internet]. 2014[cited 2015 Oct 21];22(9):2557-61. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118033/
http://www.ncbi.nlm.nih.gov/pmc/articles...
). |
Prophylactic G-CSF could help reduce alterations in the neutrophil count after CT. |
Use of G-CSF appears to be safe and effective, while contributing to cost reduction, however further randomized studies are necessary to define the correct dosage to avoid NF. |
To evaluate the association between adherence to an antimicrobial management protocol and the mortality of hospitalized NF patients(2121 Rosa RG, Goldani LZ, Santos RP. Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study. BMC Infect Dis[Internet]. 2014[cited 2015 Oct 21];14(1):1-18. Available from: http://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-286
http://bmcinfectdis.biomedcentral.com/ar...
). |
Mortality rates of patients treated according to the antimicrobial management protocol were lower when compared to mortality rates of patients treated with other ABT regimens. |
Adherence to an antimicrobial management protocol has a favorable repercussion on NF management, since it supports the rational use of antibiotics and contributes to the reduction of mortality rates. |
To compare the prophylactic use of G-CSF and/or ABT for the treatment of low-risk neutropenic patients in hospital and outpatient settings(2222 Weycker D, Barron R, Kartashov A, Legg J, Lyman GH. Incidence, treatment, and consequences of chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings. J Oncol Pharm Pract[Internet]. 2014 [cited 2015 Oct 21];20(3):190-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23824496
http://www.ncbi.nlm.nih.gov/pubmed/23824...
). |
Outpatient prophylactic treatment reduces the mortality rate and need for long-term hospitalizations, while also reducing hospital costs. |
Despite the benefits of outpatient prophylaxis, it has been proven over the last three years that most patients with low-risk NF were initially treated in the hospital setting. |
To compare the efficacy of cefepime versus ciprofloxacin in the treatment of FN patients(2323 Yasuda T, Suzuki R, Ishikawa Y, Terakura S, Inamoto Y, Yanada M, et al. Randomized controlled trial comparing ciprofloxacin and cefepime in febrile neutropenic patients with hematological malignancies. Int J Infect Dis[Internet]. 2013 [cited 2015 Oct 21];17(6):385-90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23317527
http://www.ncbi.nlm.nih.gov/pubmed/23317...
). |
Although the overall clinical response was similar between both groups, the efficacy of cefepime treatment on day 7 of CT was proven to provide a better response in the neutrophil count in high-risk NF patients. |
The efficacy of cefepime in relation to the use of ciprofloxacin on day 7 of CT was identified. Thus, the authors recommend that cefepime be used as the initial standard treatment of choice for NF and ciprofloxacin as empiric prophylactic treatment. |
To determine the value of lipopolysaccharide binding protein as a predictor of infection in patients with FN compared to other biomarkers: C-reactive protein, PCT and interleukin (2424 Garcia GRL, Español MI, Cerezuea FP, Consuega SL, Hernando HA, Esteban TP , et al. Value of lipopolysaccharide binding protein as diagnostic marker of infection in adult cancer patients with febrile neutropenia: comparison with C-reactive protein, procalcitonin, and interleukin 6. Support Care Cancer[Internet]. 2015 [cited 2015 Oct 21];23(7):2175-82. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25564222
http://www.ncbi.nlm.nih.gov/pubmed/25564...
). |
At admission of FN patients, the biomarkers of lipopolysaccharide, C-reactive, PCT and interleukin binding proteins were increased, with no significant differences between them for early detection of septic shock and bacteremia. |
At admission of neutropenic patients, the lipopolysaccharide binding protein confers early diagnostic accuracy of infection similar to that of other biomarkers studied. |
