Back
 OJEpi  Vol.7 No.2 , May 2017
Applying Multinational Association of Supportive Care of Cancer Index Score for Identifying Febrile Neutropenia Patients at High Risk of Complications at Tertiary Care Hospital, Pakistan
Abstract: Introduction: Multinational Association of Supportive Care of Cancer (MASCC) index score is a clinical tool to predict outcomes in Febrile Neutropenia patients. This risk-index score has been authenticated in international trials however local data is deficient. We aimed to determine hospital based incidence rate of serious complications in admitted chemotherapy induced febrile neutropenia patients presenting to a tertiary care hospital. We also aimed to compare proportions of serious medical complications in patients having MASCC score <21 or ≥21. Methods: A hospital based prospective close cohort study was designed and conducted at Oncology wards of The Aga Khan University from February to August 2014. Total of 88 patients, aged 16 and above, with chemotherapy induced febrile neutropenia were identified and divided on the basis of MASCC Score into low or high risk {exposure} groups. Follow up was done from day of admission (day zero) to discharge. Outcome was assessed in terms of development of serious complications. Hospital based incidence rate was estimated. The associations between outcome and qualitative variables were evaluated by using Pearson Chi-square and Fisher’s exact test. Results: Hospital based incidence rate of febrile neutropenia admission was 5.98%, 95%CI [4.88% - 7.08%]. Out of 88 patients with chemotherapy induced febrile neutropenia 85.2% patients were in the high risk group and 14.8% in the low risk group. Serious complications were found in 21.33% and no patients in high and low risk group respectively. Age > 60 (p = 0.039), MASCC score < 15 (p = 0.002) and an albumin < 2.5 mg/dl (p = 0.046) was associated with higher chance of developing serious complications. Sensitivity, specificity, positive and negative predictive value of MASCC score in predicting risk of serious complications was 21.33%, 100%, 100% and 18.06% respectively. Conclusion: MASCC risk-index score is a useful tool to identify patients at low risk of complications. Hospital based incidence rate of serious complications was 18.2%.
Cite this paper: Samoon, Z. , Beg, M. , Moosajee, M. , Kamran, M. , Masood, N. , Asghar, A. and Ahmed, A. (2017) Applying Multinational Association of Supportive Care of Cancer Index Score for Identifying Febrile Neutropenia Patients at High Risk of Complications at Tertiary Care Hospital, Pakistan. Open Journal of Epidemiology, 7, 159-174. doi: 10.4236/ojepi.2017.72014.
References

[1]   Hughes, W.T., Armstrong, D., Bodey, G.P., Bow, E.J., Brown, A.E., Calandra, T., et al. (2002) 2000 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Clinical Infectious Diseases, 34, 730-751.
https://doi.org/10.1086/339215

[2]   Klastersky, J. (2004) Management of Fever in Neutropenic Patients with Different Risks of Complications. Clinical Infectious Diseases, 39, S32-S37.
https://doi.org/10.1086/383050

[3]   Bodey, G.P., Buckley, M., Sathe, Y.S. and Freireich, E.J. (1966) Quantitative Relationships between Circulating Leukocytes and Infection in Patients with Acute Leukemia. Annals of Internal Medicine, 64, 328-340.
http://annals.org/aim/article/680517/quantitative-relationships-between-circulating-leukocytes-infection-patients-acute-leukemia
https://doi.org/10.7326/0003-4819-64-2-328


[4]   Ramphal, R. (2004) Changes in the Etiology of Bacteremia in Febrile Neutropenic Patients and the Susceptibilities of the Currently Isolated Pathogens. Clinical Infectious Diseases, 39, S25-S31.
https://doi.org/10.1086/383048

[5]   Rosenberg, P.S., Alter, B.P., Bolyard, A.A., Bonilla, M.A., Boxer, L.A., Cham, B., et al. (2006) The Incidence of Leukemia and Mortality from Sepsis in Patients with Severe Congenital Neutropenia Receiving Long-Term G-CSF Therapy. Blood, 107, 4628-4635.
https://doi.org/10.1182/blood-2005-11-4370

[6]   Lyman, G.H., Morrison, V.A., Dale, D.C., Crawford, J., Delgado, D.J., Fridman, M., et al. (2003) Risk of Febrile Neutropenia among Patients with Intermediate-Grade Non-Hodgkin’s Lymphoma Receiving CHOP Chemotherapy. Leukemia & Lymphoma, 44, 2069-2076.
https://doi.org/10.1080/1042819031000119262

[7]   Kuderer, N.M., Dale, D.C., Crawford, J., Cosler, L.E. and Lyman, G.H. (2006) Mortality, Morbidity, and Cost Associated with Febrile Neutropenia in Adult Cancer Patients. Cancer, 106, 2258-2266.
http://onlinelibrary.wiley.com/doi/10.1002/cncr.21847/full
https://doi.org/10.1002/cncr.21847


[8]   de Naurois, J., Novitzky-Basso, I., Gill, M.J., Marti, F.M., Cullen, M.H., Roila, F., et al. (2010) Management of Febrile Neutropenia: ESMO Clinical Practice Guidelines. Annals of Oncology, 21, v252-v256.
https://doi.org/10.1093/annonc/mdq196

[9]   Baskaran, N.D., Gan, G.G. and Adeeba, K. (2008) Applying the Multinational Association for Supportive Care in Cancer Risk Scoring in Predicting Outcome of Febrile Neutropenia Patients in a Cohort of Patients. Annals of Hematology, 87, 563-569.
https://doi.org/10.1007/s00277-008-0487-7

[10]   Talcott, J.A., Siegel, R.D., Finberg, R. and Goldman, L. (1992) Risk Assessment in Cancer Patients with Fever and Neutropenia: A Prospective, Two-Center Validation of a Prediction Rule. Journal of Clinical Oncology, 10, 316-322.
http://ascopubs.org/doi/pdf/10.1200/JCO.1992.10.2.316
https://doi.org/10.1200/JCO.1992.10.2.316


[11]   Klastersky, J., Paesmans, M., Rubenstein, E.B., Boyer, M., Elting, L., Feld, R., et al. (2000) The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients. Journal of Clinical Oncology, 18, 3038-3051.
http://ascopubs.org/doi/pdf/10.1200/JCO.2000.18.16.3038
https://doi.org/10.1200/JCO.2000.18.16.3038


[12]   Kern, W.V., Marchetti, O., Drgona, L., Akan, H., Aoun, M., Akova, M, et al. (2013) Oral Antibiotics for Fever in Low-Risk Neutropenic Patients with Cancer: A Double-Blind, Randomized, Multicenter Trial Comparing Single Daily Moxifloxacin with Twice Daily Ciprofloxacin plus Amoxicillin/Clavulanic Acid Combination Therapy—EORTC Infectious Diseases Group Trial XV. Journal of Clinical Oncology, 31, 1149-1156.
https://doi.org/10.1200/JCO.2012.45.8109

[13]   Inouye, S.K., van Dyck, C.H., Alessi, C.A., Balkin, S., Siegal, A.P. and Horwitz, R.I. (1990) Clarifying Confusion: The Confusion Assessment Method. A New Method for Detection of Delirium. Annals of Internal Medicine, 113, 941-948.
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.477.4525&rep=rep1&type=pdf
https://doi.org/10.7326/0003-4819-113-12-941


[14]   Khwaja, A. (2012) KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Nephron Clinical Practice, 120, c179-c184.
https://doi.org/10.1159/000339789

[15]   Uys, A., Rapoport, B.L. and Anderson, R. (2004) Febrile Neutropenia: A Prospective Study to Validate the Multinational Association of Supportive Care of Cancer (MASCC) Risk-Index Score. Supportive Care in Cancer, 12, 555-560.
https://www.ncbi.nlm.nih.gov/labs/articles/15197637/
https://doi.org/10.1007/s00520-004-0614-5


[16]   Cherif, H., Johansson, E., Bjorkholm, M. and Kalin, M. (2006) The Feasibility of Early Hospital Discharge with Oral Antimicrobial Therapy in Low Risk Patients with Febrile Neutropenia Following Chemotherapy for Hematologic Malignancies. Haematologica, 91, 215-222.
http://www.haematologica.org/content/91/2/215

[17]   Klastersky, J. (1998) Science and Pragmatism in the Treatment and Prevention of Neutropenic Infection. The Journal of Antimicrobial Chemotherapy, 41, 13-24.
https://doi.org/10.1093/jac/41.suppl_4.13

[18]   Feld, R. (2008) Bloodstream Infections in Cancer Patients with Febrile Neutropenia. The International Journal of Antimicrobial Agents, 32, S30-S33.
https://doi.org/10.1016/j.ijantimicag.2008.06.017

[19]   Kanafani, Z.A., Dakdouki, G.K., El-Chammas, K.I., Eid, S., Araj, G.F. and Kanj, S.S. (2007) Bloodstream Infections in Febrile Neutropenic Patients at a Tertiary Care Center in Lebanon: A View of the Past Decade. The International Journal of Infectious Diseases, 11, 450-453.
https://doi.org/10.1016/j.ijid.2006.12.008

[20]   Baskaran, N.D., Gan, G.G., Adeeba, K. and Sam, I.C. (2007) Bacteremia in Patients with Febrile Neutropenia after Chemotherapy at a University Medical Center in Malaysia. The International Journal of Infectious Diseases, 11, 513-517.
https://doi.org/10.1016/j.ijid.2007.02.002

[21]   Biesma, B., de Vries, E.G., Willemse, P.H., Sluiter, W.J., Postmus, P.E., Limburg, P.C., et al. (1990) Efficacy and Tolerability of Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor in Patients with Chemotherapy-Related Leukopenia and Fever. European Journal of Cancer, 126, 932-936.
https://www.ncbi.nlm.nih.gov/pubmed/2149017

[22]   Ravaud, A., Chevreau, C., Cany, L., Houyau, P., Dohollou, N., Roche, H., et al. (1998) Granulocyte-Macrophage Colony-Stimulating Factor in Patients with Neutropenic Fever Is Potent after Low-Risk but Not after High-Risk Neutropenic Chemotherapy Regimens: Results of a Randomized Phase III Trial. Journal of Clinical Oncology, 16, 2930-2936.
https://doi.org/10.1200/JCO.1998.16.9.2930

[23]   Maher, D.W., Lieschke, G.J., Green, M., Bishop, J., Stuart-Harris, R., Wolf, M., et al. (1994) Filgrastim in Patients with Chemotherapy-Induced Febrile Neutropenia. A Double-Blind, Placebo-Controlled Trial. Annals of Internal Medicine, 121, 492-501.
https://doi.org/10.7326/0003-4819-121-7-199410010-00004

[24]   Ozer, H., Armitage, J.O., Bennett, C.L., Crawford, J., Demetri, G.D., Pizzo, P.A., et al. (2000) 2000 Update of Recommendations for the Use of Hematopoietic Colony-Stimulating Factors: Evidence-Based, Clinical Practice Guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. Journal of Clinical Oncology, 18, 3558-3585.
http://ascopubs.org/doi/pdf/10.1200/JCO.2000.18.20.3558
https://doi.org/10.1200/JCO.2000.18.20.3558


[25]   Hui, E.P., Leung, L.K., Poon, T.C., Mo, F., Chan, V.T., Ma, A.T., et al. (2011) Prediction of Outcome in Cancer Patients with Febrile Neutropenia: A Prospective Validation of the Multinational Association for Supportive Care in Cancer Risk Index in a Chinese Population and Comparison with the Talcott Model and Artificial Neural Network. Supportive Care in Cancer, 19, 1625-1635.
https://doi.org/10.1007/s00520-010-0993-8

[26]   Klastersky, J., Paesmans, M., Georgala, A., Muanza, F., Plehiers, B., Dubreucq, L., et al.(2006) Outpatient Oral Antibiotics for Febrile Neutropenic Cancer Patients Using a Score Predictive for Complications. Journal of Clinical Oncology, 24, 4129-4134.
https://doi.org/10.1200/JCO.2005.03.9909

 
 
Top