Discharge Timing for Children With Cancer and Neutropenia

Chemotherapy-induced neutropenia is a common adverse effect in children with cancer, yet there are less serious causes of febrile neutropenia for which extended in-hospital treatment might be unnecessary, according to a study published in Cochrane Database of Systemic Reviews.

Although children with neutropenia may be more subject to infections and related complications, there may be some instances where the standard hospitalization and antibiotic treatments may not be necessary. The authors collected various publications from multiple organizations in order to see how different discharge times affected children with cancer and neutropenia, looking at both randomized controlled trials and controlled clinical trials.

Discharge times were categorized as very early with an average of less than 24 hours, early with an average of less than 5 days, and non-early with an average of 5 days or more.

The team included 2 randomized controlled trials: Santolaya 2004 and Brack 2012. Santolaya 2004 compared early discharge to non-early discharge and found no clear evidence of difference in treatment failure or duration of treatment; costs were lower in the early discharge group. Brack 2012 compared very early discharge to early discharge and found no clear evidence of difference in treatment failure or median duration of any antimicrobial treatment; costs were not assessed. It is possible, however, that this absence of clear evidence indicates a lack of power in the studies.

“Evidently, there are still profound gaps regarding very early and early discharge in children with cancer and febrile neutropenia,” the authors wrote.

They concluded that there was limited data regarding safety of early discharge compared to non-early discharge for children with low risk of invasive infection. They hope that future studies will utilize a larger sample size and “aim for uniform and objective criteria regarding the identification of a low-risk febrile neutropenic episode.”