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Symptom Management and Supportive Care

Cancer-Associated Neutropenic Fever: Clinical Outcome and Economic Costs of Emergency Department Care

^aDepartment of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; ^bDepartment of Pharmacy, Northwestern Memorial Hospital, Chicago, Illinois, USA; ^cStritch School of Medicine, Loyola University, Chicago, Illinois, USA; ^dJesse Brown VA Medical Center/Mid-West Center for Health Services and Policy Research, Chicago, Illinois, USA; ^eDivision of Hematology/Oncology and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA

Key Words. Febrile neutropenia • Neutropenic fever • Emergency department • Cancer-induced neutropenia

Correspondence: Charles L. Bennett, M.D., Ph.D., VA Lakeside Medical Center, Division of General Internal Medicine, Department of Medicine, 400 E. Ontario Street, Suite 205, Chicago, Illinois 60611, USA. Telephone: 312-469-4410; Fax: 312-640-2496; e-mail: cbenne{at}northwestern.edu

Received March 21, 2007; accepted for publication June 22, 2007.

Purpose. Febrile neutropenia (FN) is a common, costly, and potentially fatal complication in oncology. While FN in the inpatient setting has been extensively studied, only one study has evaluated emergency department (ED) care for FN cancer patients. That study found that 96% of patients survived the complication. We evaluated clinical and economic outcomes for cancer patients with chemotherapy-associated FN treated in an ED.

Methods. ED records for consecutive oncology patients with FN were reviewed for information on death, intensive care unit (ICU) use, blood cultures, and costs.

Results. Forty-eight patients (n = 57 visits) were evaluated. Six patients died from FN (12%) and four received ICU care within 2 weeks and survived (8%). Blood cultures were positive for 37% of the ED visits. The median ED time was 3.3 hours. In 91% of visits, i.v. antibiotics were administered in the ED, ordered at a median of 1.7 hours from triage (interquartile range [IQR], 1.2–2.8 hours). All patients with death or ICU in 2 weeks and all but one patient with positive blood cultures received antibiotics. The median per patient ED costs were $1,455 (IQR, $1,300–$1,579)—42.4% for hospital/nursing, 23.5% for radiology, 20.8% for physician services, 10.9% for diagnostic tests, and 2.4% for antibiotics.

Conclusions. Cancer patients with FN in this sample presenting to the ED frequently had no identified source of infection. One third of the patients had positive ED blood cultures and one fifth died or required ICU care within 2 weeks. Costs of ED care were similar to the cost of a single day of inpatient care.

Disclosure of potential conflicts of interest is found at the end of this article.