Department of Acute Medicine and Critical Care, The Christie, Wilmslow Road, Manchester, UK.
Department of Supportive Care, The Christie, Wilmslow Road, Manchester, UK.
Support Care Cancer. 2018 Sep;26(9):2937-2940. doi: 10.1007/s00520-018-4194-1. Epub 2018 Apr 19.
Outpatient management of low risk febrile neutropenia patients (LRFN) identified by the MASCC score is a safe and effective strategy. Early supportive care has been shown to improve outcomes in patients with care. We developed an innovative ambulatory outpatient "enhanced supportive care" (ESC) clinic combining emergency oncology and supportive care through which we incorporated the management of patients with LRFN.
An ESC clinic was started in January 2017 at a tertiary cancer hospital in the North West of England. An integral part of the clinic was an ambulatory pathway for patients presenting with LRFN. Patients with a MASCC score ≥ 21 and an Early Warning Score ≤ 3 were potentially eligible for the pathway. Suitable patients were managed with oral amoxicillin/clavulanic acid (500/125 mg TDS) and ciprofloxacin (500 mg BD) or moxifloxacin 400 mg OD if penicillin allergic. All patients had one dose of intravenous meropenem on arrival.
In its first year, 68 patients with LRFN were managed through the clinic. Table 1 shows the demographic data of the patients. Six (8.8%) patients had a 7-day readmission. There were no serious complications in the cohort.
The ESC clinic maybe an effective method for delivering outpatient ambulatory management of patients with LRFN.
通过 MASCC 评分识别的低危发热性中性粒细胞减少症（LRFN）患者的门诊管理是一种安全有效的策略。早期支持性护理已被证明可以改善患者的预后。我们开发了一种创新的门诊“强化支持性护理”（ESC）诊所，通过该诊所将肿瘤急症和支持性护理相结合，其中纳入了 LRFN 患者的管理。
2017 年 1 月，在英格兰西北部的一家三级癌症医院开设了 ESC 诊所。该诊所的一个组成部分是 LRFN 患者的门诊通道。MASCC 评分为≥21 且预警评分≤3 的患者有资格进入该通道。适合的患者接受口服阿莫西林/克拉维酸（500/125mg TDS）和环丙沙星（500mg BD）或青霉素过敏患者的莫西沙星 400mg OD 治疗。所有患者在到达时均接受一次静脉美罗培南治疗。
在第一年，通过该诊所管理了 68 例 LRFN 患者。表 1 显示了患者的人口统计学数据。有 6 名（8.8%）患者在 7 天内再次入院。该队列中没有发生严重并发症。
ESC 诊所可能是为 LRFN 患者提供门诊管理的有效方法。
