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    Acute oncology care: a narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors.

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    Authors
    Knight, T
    Ahn, S
    Rice, T
    Cooksley, Timothy J
    Affiliation
    University Hospital of South Manchester, Manchester, UK
    Issue Date
    2017-10-06
    
    Metadata
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    Abstract
    Cancer care has become increasingly specialized and advances in therapy have resulted in a larger number of patients receiving care. There has been a significant increase in the number of patients presenting with cancer related emergencies including treatment toxicities and those directly related to the malignancy. Suspected neutropenic sepsis is an acute medical emergency and empirical antibiotic therapy should be administered immediately. The goal of empirical therapy is to cover the most likely pathogens that will cause life-threatening infections in neutropenic patients. Patients with febrile neutropenia are a heterogeneous group with only a minority of treated patients developing significant medical complications. Outpatient management of low risk febrile neutropenia patients identified by the MASCC score is a safe and effective strategy. Immunotherapy with "checkpoint inhibitors" has significantly improved outcomes for patients with metastatic melanoma and evidence of benefit in a wide range of malignancies is developing. Despite these clinical benefits a number of immune related adverse events have been recognised which can affect virtually all organ systems and are potentially fatal. The timing of the onset of the adverse events is dependent on the organ system affected and unlike anti-neoplastic therapy can be delayed significantly after initiation or completion of therapy. The field of Acute Oncology is changing rapidly. Alongside, the traditional challenge of neutropenic sepsis there are many emerging toxicities. Further research into the optimal management, strategies and pathways of acutely unwell patients with cancer is required.
    Citation
    Acute oncology care: a narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors. 2017, Eur J Intern Med
    Journal
    European Journal of Internal Medicine
    URI
    http://hdl.handle.net/10541/620688
    DOI
    10.1016/j.ejim.2017.09.025
    PubMed ID
    28993098
    Type
    Article
    Language
    en
    ISSN
    1879-0828
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ejim.2017.09.025
    Scopus Count
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