Fledderus, N. (2020) Tijd voor thuisbehandeling _______________________ Validatie van het Multinational Association for Supportive Care in Cancer (MASCC) scoresysteem bij patiënten met febriele neutropenie in het Deventer Ziekenhuis. thesis, Medicine.
Full text available on request.Abstract
Purpose of the study In the general hospital: ‘Deventer Hospital’ all patients with chemotherapy-induced febrile neuropenia are nowadays treated with intravenous antibiotics.Years ago, the Multinational Association for Supportive Care in Cancer (MASCC)1 developed a prognostic tool to identify low risk patients who can be treated in an outpatient setting. In the following years, studies have been trying to validate the scoring system, but a statistically validated reference for the application of the MASCC-score remains unclear. As a result of that, there is no place for the MASCC-score in the decision making of patients with febrile neutropenia in this hospital. This study aims to validate the MASCC-score in the population of the ‘Deventer Hospital’ and to evaluate its usefulness in restricting the unnecessary hospitalizations. Method A retrospective analysis of the MASCC prognostic tool in patients with febrile neutropenia was performed using data obtained from the patient population of the hospital ‘Deventer Hospital’ from 2008 to 2020. Adult oncology patients (≥18 years old) with fever (≥38.2 Celcius) and neutropenia (<0.5x109cells/L), during a chemotherapeutic treatment were included. Clinical and laboratory parameters were extracted from the electronic patient dossier and the MASCC-score was calculated. The primary outcome is the incidence of complications or death. Complications were defined in the same way as the original study of Klastersky et al.1 did in combination with the absence of clinical response to the initial antibiotic regimen. We focused our analysis on stable patients. A stable condition is defined in the same way as Carmona et al.2 did with addition of the list of the American society of clinical oncology (ASCO)3. Logistic regression analysis, chi-square tests and t-test were performed to find correlations between multiple variables and the outcome. As a secondary outcome the prognostic tool of the Clinical Index of Stable Febrile Neutropenia (CISNE) was evaluated. Results A total of 308 episodes where analysed, of which 70 episodes where complicated. The positive predictive value of a low risk MASCC-score (≥ 21 points) in this population is 86.8%, the sensitivity 80.3%. If we only include the 211 stable episodes, the positive predictive value improved to 91.8% and the sensitivity to 85.3%. An increase of the threshold of the MASCC-score results in a better prediction of complications (specificity), but the tool would be less exact in ruling out patients who can be treated at home (sensitivity). In a subanalysis of the CISNE-score, we compared the MASCC- and the CISNE-score in a Receiver Operating Characteristic (ROC) curve. The MASCC-score (AUC value 0.765) seems to be a better predictive model than the CISNE-score (AUC value 0.668). Conclusion The MASCC-score seems to be a valid tool for identifying patients with a low risk of complications under the conditions that it is exclusively applied to patients who are in a stable condition at the emergency room.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | dr. Huugen, D. and dr. Siemes, C. |
| Faculty: | Medical Sciences |
| Date Deposited: | 19 Sep 2023 11:31 |
| Last Modified: | 19 Sep 2023 11:31 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3688 |
Actions (login required)
 |
View Item |