PURPOSE: The Multinational Association for Supportive Care in Cancer (MASCC) score is used to risk stratify outpatients with febrile neutropenia (FN). However, it is rarely used in hospital settings . We aimed to describe management, use of MASCC score, and outcomes among hospitalized patients with FN.
METHODS: We conducted a retrospective cohort study of patients with cancer and FN . We collected patient demographics, cancer characteristics, microbiological profile, MASCC score, utilization of critical care therapies, documentation of goals of care (GOC), and inpatient deaths . Outcomes associated with low- (≥ 21) versus high-risk (< 21) MASCC scores are presented as absolute differences .
RESULTS: Of 193 patients, few (2%, n = 3) had MASCC scores documented, but when calculated , 52% (n = 101) had a high-risk score (< 21). GOC were discussed in 12% (n = 24) of patients . Twenty one percent (n = 40) required intermediate/ICU level of care, and 12% (n = 23) died in the hospital . Those with a low-risk score were 33% less likely to require intermediate/ICU care (95% CI 23 to 44 %) and 19% less likely to die in the hospital (95% CI 10% to 27 %) compared to those with high-risk score .
CONCLUSIONS: MASCC score was rarely used for hospitalized patients with FN, but high-risk score was associated with worse outcomes . Education efforts to incorporate MASCC score into the workflow may help identify patients at high risk for complications and help clinicians admit these patients to a higher level of care (e.g., intermediate/ICU care) or guide them to initiate earlier GOC discussions.
Index: Cancer, Febrile neutropenia, Goals of care, Multinational Association for Supportive Care Score, Neutropenic fever