Clinical Pathway for Oncology Patient Presenting with New Fever
- Related Pathways
- Fever Non-Oncology CVC, ED
- Fever, All Settings
- Sepsis, ED, Inpatient, PICU
- As Clinically Indicated
Team Assessment
- History and Physical Exam
- Obtain CVC or IV access
- Order labs and blood cultures, consider further diagnostic studies
- Review considerations for antibiotic choice and order antibiotics as indicated
- Contact Oncology after placing orders
- Consider stress steroids (except for CAR T-cell recipients)
- Avoid ibuprofen
General oncology, autologous SCT, CAR T-cell ≥ 1 mo
- Antibiotic Recommendations for Special Populations
- CAR T-cell < 1 mo
- Allogeneic Stem Cell Transplant
- Gene Therapy Recipients
Broviac, PICC,
Medcomp/Pheresis Catheter
Medcomp/Pheresis Catheter
Port
No Line
Check ANC
Can use ANC w/in past 24 hrs
Can use ANC w/in past 24 hrs
Check ANC
Can use ANC w/in past 24 hrs
Can use ANC w/in past 24 hrs
Inpatient Treatment
ANC < 200
ANC ≥ 200
ANC < 200
ANC ≥ 200
No antibiotics indicated
Does not meet all criteria
Meets all criteria
Discharge home
Does not meet all criteria
Meets all criteria
Discharge home
Inpatient Treatment
Inpatient Treatment
Posted: February 2008
Revised: November 2024
Revised: November 2024
Evidence
- Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update
- Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update by the Infectious Diseases Society of America
- Prevention and Treatment of Cancer-related Infections, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology
- Guideline for the Management of Fever and Neutropenia in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update