4
Assessment
Î An oncology patient with fever and neutropenia during or after
chemotherapy should meet each of the following criteria to receive empiric
therapy as an outpatient:
• Residence ≤1 hour or ≤30 miles (48 km) from clinic or hospital
• Patient's primary care physician or treating oncologist agrees to outpatient management
• Able to comply with logistical requirements, including frequent clinic visits
• Family member or caregiver at home 24 hours a day
• Access to a telephone and transportation 24 hours a day
• No prior history of non-compliance with treatment protocols
Î Perform a systematic risk assessment using a validated index.
• Of the available risk indices for adults, the MASCC risk index (Table 3) has been
evaluated most thoroughly.
• Talcott's rules (Table 2) have also been validated in prospective studies.
▶ Patients meeting any of the criteria listed in Table 4, those with MASCC score
<21, or those in Talcott Groups 1-3 should be managed as inpatients.
▶ Neither a currently available risk index nor the criteria in Table 4 should substitute for
clinical judgment when deciding whether or not a given patient with a FNE should be
admitted to the hospital for inpatient management.
▶ The FNE should be managed in the hospital if the clinician has any reservations with
respect to the accuracy of an index for an individual, even if the patient is classified as
low risk (MASCC score ≥21 or Talcott Group 4).
