Outpatient treatment for people with cancer who develop a low-risk febrile neutropaenic event

• Published in: Cochrane database of systematic reviews 2019-03, Vol.3 (3), p.CD009031
• Main Authors: Rivas-Ruiz, Rodolfo, Villasis-Keever, Miguel, Miranda-Novales, Guadalupe, Castelán-Martínez, Osvaldo D, Rivas-Contreras, Silvia
• Format: Article
• Language: English
• Subjects: 'ORPHAN' TOPICS CURRENTLY BEING ADDRESSED; Adolescent; Adult; Ambulatory Care; Anti-Bacterial Agents - therapeutic use; Cancer; Child; Febrile Neutropenia - chemically induced; Febrile Neutropenia - drug therapy; Febrile Neutropenia - mortality; Female; Fever - etiology; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Neoplasms - complications; Outcome Assessment, Health Care; Quality of Life; Randomized Controlled Trials as Topic; Time Factors; Treatment Failure
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD009031.pub2

People with febrile neutropaenia are usually treated in a hospital setting. Recently, treatment with oral antibiotics has been proven to be as effective as intravenous therapy. However, the efficacy and safety of outpatient treatment have not been fully evaluated. To compare the efficacy (treatment failure and mortality) and safety (adverse events of antimicrobials) of outpatient treatment compared with inpatient treatment in people with cancer who have low-risk febrile neutropaenia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library, MEDLINE via Ovid (from 1948 to November week 4, 2018), Embase via Ovid (from 1980 to 2018, week 48) and trial registries (National Cancer Institute, MetaRegister of Controlled Trials, Medical Research Council Clinical Trial Directory). We handsearched all references of included studies and major reviews. Randomised controlled trials (RCTs) comparing outpatient with inpatient treatment for people with cancer who develop febrile neutropaenia. The outpatient group included those who started treatment as an inpatient and completed the antibiotic course at home (sequential) as well as those who started treatment at home. Two review authors independently assessed trial eligibility, methodological quality, and extracted data. Primary outcome measures were: treatment failure and mortality; secondary outcome measures considered were: duration of fever, adverse drug reactions to antimicrobial treatment, duration of neutropaenia, duration of hospitalisation, duration of antimicrobial treatment, and quality of life (QoL). We estimated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data; we calculated weighted mean differences for continuous data. Random-effects meta-analyses and sensitivity analyses were conducted. We included ten RCTs, six in adults (628 participants) and four in children (366 participants). We found no clear evidence of a difference in treatment failure between the outpatient and inpatient groups, either in adults (RR 1.23, 95% CI 0.82 to 1.85, I 0%; six studies; moderate-certainty evidence) or children (RR 1.04, 95% CI 0.55 to 1.99, I 0%; four studies; moderate-certainty evidence). For mortality, we also found no clear evidence of a difference either in studies in adults (RR 1.04, 95% CI 0.29 to 3.71; six studies; 628 participants; moderate-certainty evidence) or in children (RR 0.63, 95% CI 0.15 to 2.70; three studies; 329 participan