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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis

Review published: 2011.

Bibliographic details: Teuffel O, Ethier MC, Alibhai SM, Beyene J, Sung L.  Outpatient management of cancer patients with febrile neutropenia: a systematic review and meta-analysis. Annals of Oncology 2011; 22(11): 2358-2365. [PubMed: 21363878]

Quality assessment

The review concluded that outpatient management of febrile neutropenia presented a safe and efficacious alternative to in-patient treatment. However, interpretation of the data may have been limited by variations between studies. The authors' conclusions reflected the evidence presented but variation between the included studies means that their conclusions should be interpreted with caution. Full critical summary


BACKGROUND: In some centers, outpatient management for cancer patients with low-risk febrile neutropenia (FN) has been implemented into routine clinical practice. Our objective was to evaluate the current level of evidence before supporting widespread adoption of outpatient management for this population.

METHODS: We systematically reviewed randomized controlled trials evaluating efficacy and safety of outpatient management of FN.

RESULTS: From 1448 reviewed articles, 14 studies were included for meta-analysis. (i) Inpatient versus outpatient setting (6 studies) was not significantly associated with treatment failure [risk ratio 0.81; 95% confidence interval (CI) 0.55-1.19; P = 0.28]. Death occurred in 13 of 742 FN episodes with no difference between the two groups (risk ratio 1.11; 95% CI 0.41-3.05; P = 0.83). (ii) Outpatient oral versus outpatient parenteral antibiotics (8 studies) were similarly efficacious with no association between route of drug administration and treatment failure (risk ratio 0.93; 95% CI 0.65-1.32; P = 0.67). No death occurred in 857 FN episodes.

CONCLUSION: Based on the current literature, outpatient treatment of FN is a safe and efficacious alternative to inpatient management. Variation between studies in terms of time to discharge, choice of antibiotic class, and age of study population may limit the interpretation of the data.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

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