2009 年澳大利亚成人癌症患者中性粒细胞减少性发热管理的临床实践调查。

An Australian survey of clinical practices in management of neutropenic fever in adult cancer patients 2009.

机构信息

Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.

出版信息

Intern Med J. 2011 Jan;41(1b):110-20. doi: 10.1111/j.1445-5994.2010.02342.x.

DOI:10.1111/j.1445-5994.2010.02342.x

PMID:21272175

Abstract

BACKGROUND

An abundance of new evidence regarding treatment strategies for neutropenic fever is likely to contribute to variability in practice across institutions and clinicians alike.

AIMS

To describe current clinical practices in Australia, by surveying haematologists, oncologists and infectious diseases physicians involved in cancer care.

METHODS

Clinician members from Australian professional associations, accounting for the vast majority of Australian cancer specialists, were invited to participate in an electronic survey, comprising of a clinical case-based questionnaire. Clinical practice areas explored were: use of risk-assessment and empiric antibiotic strategies across various treatment settings; use of anti-bacterial prophylaxis; and use of granulocyte-colony stimulating factors for established neutropenic fever and for secondary prophylaxis.

RESULTS

A total of 252 clinicians returned responses (approximately 30% response rate). The majority (>70%) were representative of practices in public, major city, tertiary referral hospitals. Less than half of clinicians were aware of risk-assessment tools and less than quarter currently used ambulatory care strategies. If adequate resources were made available, more than 80% were willing to use risk-assessment tools and 60% more clinicians were likely to use ambulatory care strategies. Most clinicians prescribed dual therapy parenteral antibiotics, even for clinically stable patients (53% haematologists, 56% oncologists). Granulocyte-colony stimulating factor was used frequently as secondary prophylaxis in the breast cancer case (91%), follicular lymphoma case (59%) and non-small cell lung cancer case (31%). Fluoroquinolone prophylaxis was infrequently prescribed (19% oncologists, 30% haematologists).

CONCLUSIONS

Evidence-practice gaps were identified around the use of risk-assessment-based empiric therapy, and help to inform better clinical guidance.

摘要

背景

针对中性粒细胞减少性发热的治疗策略方面有大量新证据，这可能导致不同医疗机构和临床医生之间的实践存在差异。

目的

通过调查参与癌症治疗的血液科医生、肿瘤学家和传染病医生，描述澳大利亚当前的临床实践情况。

方法

邀请澳大利亚专业协会的临床医生成员（占绝大多数澳大利亚癌症专家）参与一项电子调查，该调查包含一个基于临床病例的问卷。调查的临床实践领域包括：在各种治疗环境中使用风险评估和经验性抗生素策略；使用抗菌预防措施；以及在确定中性粒细胞减少性发热和二级预防时使用粒细胞集落刺激因子。

结果

共有 252 名临床医生做出了回应（约 30%的回应率）。大多数（>70%）代表了公共、主要城市、三级转诊医院的实践情况。不到一半的临床医生了解风险评估工具，不到四分之一的临床医生目前使用门诊护理策略。如果有足够的资源，超过 80%的人愿意使用风险评估工具，并且有 60%以上的临床医生更有可能使用门诊护理策略。大多数临床医生为临床稳定的患者开双重治疗的静脉内抗生素，即使是（53%的血液科医生，56%的肿瘤学家）。粒细胞集落刺激因子在乳腺癌病例（91%）、滤泡性淋巴瘤病例（59%）和非小细胞肺癌病例（31%）中经常被用作二级预防。氟喹诺酮类预防药物很少被开处方（19%的肿瘤学家，30%的血液科医生）。