Authors (including presenting author) :
Tseung S(1), Chan KLL(1), Chan WLF(1), Mak WMV(1), Lee KKH(1)
Affiliation :
(1)Division of Haematology, Department of Medicine & Geriatrics, Princess Margaret Hospital
Introduction :
Neutropenic sepsis and catastrophic bleeding are potentially life-threatening complications of intensive chemotherapy in the treatment of haematological malignancies. When patients are managed in outpatient settings, close monitoring during cytopenic phase may allow timely intervention to prevent serious complications.
Objectives :
To study the effectiveness of the new policy of daily ambulatory care to haematology patients receiving chemotherapy.
Methodology :
Haematology Day Unit Cell Count Clinic (DHCC) was introduced in June 2017 to follow up patients receiving intensive chemotherapy and considered suitable for outpatient management. During cytopenic phase (neutrophil< 1x10^9/L, platelets< 20x10^9/L), patients were required to attend DHCC at least once every other day. Phone consultation with patients for systems review was conducted by haematology nurse on days without clinic visit, and patients would be advised to attend hospital for assessment if necessary. Before introducing DHCC, patient care was not standardised and a patient might attend clinic 1-3 times/week. Other supportive care measures, like red cell and platelet transfusions, the use of G-CSF and antimicrobials as infection prophylaxis, did not change.
Result & Outcome :
To evaluate the effectiveness of DHCC, outcomes of patients treated with intensive chemotherapy during Jun 2015 to May 2017 (old period) and Jun 2017 to May 2019 (new period) were compared. The primary outcome was the rate of unscheduled admission during a chemotherapy cycle. The secondary outcomes included the rate of unscheduled admission due to neutropenic fever and 100-day all-cause mortality after chemotherapy. Age and sex adjusted odd ratios obtained by multivariable logistic regression were used to compare the outcomes. There were 210 and 239 cycles of chemotherapy delivered to 69 patients in old period (male 54%, median age 54 [IQR 42-63] years) and 67 patients in new period (male 54%, median age 57 [IQR 50-62] years) respectively. Although not reaching statistical significance, reduction in unscheduled admission rate from 11.4% to 7.9% (OR 0.44, p=0.15, 95% CI 0.17-1.11); unscheduled admission rate due to neutropenic fever from 6.7% to 2.9% (OR 0.43, p=0.08, 95% CI 0.17-1.07); 100-day all-cause mortality from 3.8% to 1.7% (OR 0.38, p=0.18, CI 0.09-1.58) in new period in comparison to old period was observed. In conclusion, a trend towards significance was reached in the reduction of unscheduled admissions due to neutropenic fever after the establishment of DHCC. A standardised protocol in post-chemotherapy care might streamline patient care, minimise adverse complications and improve treatment outcomes.
