KANSER HASTALARINDA FEBRİL NÖTROPENİ RİSKİNİN VE FEBRİL NÖTROPENİ YÖNETİMİNİN DEĞERLENDİRİLMESİ

Abstract

Febrile neutropenia (FN) is the most important dose-limiting side effect of chemotherapy, occurring in approximately 19% of cancer patients. This study aimed to evaluate the risk factors for development of FN among cancer patients, to assess the compliance of FN prophylaxis and treatment processes with international clinical guidelines, and to identify and prevent drug-related problems (DRPs) through the active involvement of a clinical pharmacist in a multidisciplinary team. The study was conducted as a cross-sectional investigation with retrospective (January 2020–December 2020) and prospective (February 2021–February 2022) periods at the Hacettepe University Oncology Hospital. A total of 991 patients in the retrospective period, and 521 patients in the prospective period were evaluated. It was observed that 131 (94.9%) patients in the prospective period and 187 (89.5%) patients in the retrospective period used granulocyte-colony stimulating factor (G-CSF) for primary prophylaxis (p=0.072). Notably, G-CSF was used in 22 (15.5%) patients without risk in the retrospective period, while only 3 (0.3%) patients without risk received G-CSF in the prospective period (p<0.001). Regarding antibacterial prophylaxis, the prospective period demonstrated a significant improvement in the initiation of treatment at the appropriate time (p=0.04) and the use of prophylaxis for the recommended duration (p<0.001). Overall compliance with the 4 criteria assessing antibacterial prophylaxis increased from 72.72% in the retrospective period to 90.90% in the prospective period (p<0.001). Similarly, compliance with the 4 criteria for antifungal prophylaxis increased from 71% in the retrospective period to 93.5% in the prospective period (p<0.001). During the prospective period, 346 drug-related problems (DRPs) were identified among 323 patients, (1.07 DRPs per patient). The detailed evaluation of patients during each chemotherapy cycle by a multidisciplinary team, including the determination of FN risk, can significantly enhance the appropriate use of prophylactic antimicrobials in high-risk patients and optimize antimicrobial management during FN episodes.