New guidelines have been issued for the prevention and management of neutropenic sepsi in younger cancer patients
The National Institute for Health and Clinical Excellence said it aimed to address shortcomings and regional variations in responses to this increasingly common and potentially fatal complication of cancer treatment in children, young people and adults with cancer.
Systemic therapies to treat cancer - notably chemotherapy - carry with them the risk of suppressing the bone marrow’s ability to produce neutrophils, a type of white blood cell. They thereby affect the body’s capacity to combat infection.
When they are neutropenic, patients are vulnerable to sepsis (rapid onset invasive infection).
NICE notes evidence suggesting national variation across a range of criteria, including thresholds for diagnosis; oral or intravenous antibiotics; use of primary and secondary antibiotic prophylaxis and bone marrow growth factor prophylaxis, and inpatient or outpatient management policies.
The key priorities for implementation identified in the updated guidelines include the following directions:
- Treat suspected neutropenic sepsis as an acute medical emergency and offer antibiotic therapy immediately.
- Allocate a healthcare professional with competence in managing complications of anti-cancer treatment to assess the patient’s risk of septic complications within 24 hours of presentation to secondary or tertiary care. The risk assessment should be based on presentation features and use a validated risk scoring system.
- Diagnose neutropenic sepsis in patients having anti-cancer treatment whose neutrophil count is equal to or lower than 0.5 x 109/litre and who have either a temperature higher than 38oC or other signs or symptoms consistent with clinically significant sepsis.
- Provide patients undergoing anti-cancer treatment and their carers with written and oral information before starting and throughout treatment on neutropenic sepsis; how and when to contact 24-hour specialist oncology advice and how and when to seek emergency care.