Approach to Fever Assessment in Ambulatory Cancer Patients Receiving Chemotherapy

Guideline Objective

• To provide advice regarding the assessment of fever in cancer patients in the community who are receiving chemotherapy, given the potential for serious complications that is associated with it.
• To investigate whether there are predictors that are associated with a poor outcome; to determine where and how quickly the assessment should take place for these patients and who can/should perform the assessment; and what advice, information, or education should be provided to patients receiving chemotherapy in the community should they develop a fever.

Patient Population

Adult patients with cancer (i.e., solid tumours or lymphoma) receiving chemotherapy in an outpatient setting who have a fever at home.

Emergency department, in-hospital, and outpatient management of febrile neutropenia or serious infection are beyond the scope of the guideline (Table 1-1). There is abundant advice on managing patients after the diagnosis of febrile neutropenia is made (1-5). Patients who have had hematopoietic stem cell transplantation or who have acute leukemia or myelodysplastic syndrome are excluded secondary to the pathophysiologic differences in prognosis in the setting of fever.

Intended Guideline Users

Family physicians, emergency physicians and nurses, medical oncologists, hematologists, pharmacists, chemotherapy and community nurses, and health system administrators.

Research Question(s)

1. How does temperature relate to risk for febrile neutropenia, serious infection, or death?
2. What are the clinical predictors for the development of febrile neutropenia?
3. What is the relationship between timing or location of fever assessment, the personnel doing the fever assessment, and the outcome of a fever episode?
4. Do the type, quantity, and content of information provided to patients affect their choice about when and where to seek care for fever?