Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study
| dc.contributor.advisor | Hendricks, Marc | |
| dc.contributor.advisor | Davidson, Alan | |
| dc.contributor.author | Adekunle, Motunrayo | |
| dc.date.accessioned | 2022-06-22T13:48:36Z | |
| dc.date.available | 2022-06-22T13:48:36Z | |
| dc.date.issued | 2022 | |
| dc.date.updated | 2022-06-08T08:44:54Z | |
| dc.description.abstract | Background: Febrile neutropenia (FN) is the commonest fatal acute complication of cancer treatment in children. The need for regional clinical decision rules allowing for home-based care in those at low risk for adverse outcomes has been identified. Aims: To evaluate the prevalence and potential risk factors for FN, identify adverse outcomes and validate a tool to identify risk for adverse outcomes in a cohort of children treated for cancer at the Red Cross War Memorial Children's Hospital, Cape-Town, South Africa. Methodology: A retrospective cohort study from 1st January 2017 to 31st December 2019. Results: In all, 179 patients had chemotherapy and 267 FN episodes occurred. Independent predictors of FN were AML (p = 0.039), ALL (p = 0.020) and intensive chemotherapy (p = < 0.001). Mucositis (p = 0.001), CVAD (p = 0.004, haematologic malignancies (p = 0.040), blood transfusion during FN episode (p = 0.001) and severe neutropenia (white cell counts< 0.3 x 109 cells/L) (p = < 0.001) were risk factors for adverse outcomes. The mortality rate from FN was 3.57%. Independent predictors of adverse outcomes were AML (p = 0.001), CVAD in-situ (p = 0.019) and severe neutropenia (p = 0.005). Validation of risk stratification for adverse outcomes using the Swiss Paediatric Oncology Group (SPOG) index with a cut-off value of nine demonstrated a sensitivity and specificity of 52.3% and 62.0%, respectively. Positive and negative predictive values were 56.3% and 58.2%, respectively, with an overall accuracy of 57.4%. In our cohort, coordinates of the curve are best able to predict adverse outcomes with a cut-off value of 7.5. Conclusion: Adverse outcomes from treatment are likely in children with AML, severe neutropenia and those with CVADs in-situ. A lower cut-off of 7.5 using the SPOG FN risk index best predicted adverse outcomes in our cohort. | |
| dc.identifier.apacitation | Adekunle, M. (2022). <i>Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study</i>. (). ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. Retrieved from http://hdl.handle.net/11427/36504 | en_ZA |
| dc.identifier.chicagocitation | Adekunle, Motunrayo. <i>"Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study."</i> ., ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2022. http://hdl.handle.net/11427/36504 | en_ZA |
| dc.identifier.citation | Adekunle, M. 2022. Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study. . ,Faculty of Health Sciences ,Department of Paediatrics and Child Health. http://hdl.handle.net/11427/36504 | en_ZA |
| dc.identifier.ris | TY - Master Thesis AU - Adekunle, Motunrayo AB - Background: Febrile neutropenia (FN) is the commonest fatal acute complication of cancer treatment in children. The need for regional clinical decision rules allowing for home-based care in those at low risk for adverse outcomes has been identified. Aims: To evaluate the prevalence and potential risk factors for FN, identify adverse outcomes and validate a tool to identify risk for adverse outcomes in a cohort of children treated for cancer at the Red Cross War Memorial Children's Hospital, Cape-Town, South Africa. Methodology: A retrospective cohort study from 1st January 2017 to 31st December 2019. Results: In all, 179 patients had chemotherapy and 267 FN episodes occurred. Independent predictors of FN were AML (p = 0.039), ALL (p = 0.020) and intensive chemotherapy (p = < 0.001). Mucositis (p = 0.001), CVAD (p = 0.004, haematologic malignancies (p = 0.040), blood transfusion during FN episode (p = 0.001) and severe neutropenia (white cell counts< 0.3 x 109 cells/L) (p = < 0.001) were risk factors for adverse outcomes. The mortality rate from FN was 3.57%. Independent predictors of adverse outcomes were AML (p = 0.001), CVAD in-situ (p = 0.019) and severe neutropenia (p = 0.005). Validation of risk stratification for adverse outcomes using the Swiss Paediatric Oncology Group (SPOG) index with a cut-off value of nine demonstrated a sensitivity and specificity of 52.3% and 62.0%, respectively. Positive and negative predictive values were 56.3% and 58.2%, respectively, with an overall accuracy of 57.4%. In our cohort, coordinates of the curve are best able to predict adverse outcomes with a cut-off value of 7.5. Conclusion: Adverse outcomes from treatment are likely in children with AML, severe neutropenia and those with CVADs in-situ. A lower cut-off of 7.5 using the SPOG FN risk index best predicted adverse outcomes in our cohort. DA - 2022_ DB - OpenUCT DP - University of Cape Town KW - Haematology-Oncology LK - https://open.uct.ac.za PY - 2022 T1 - Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study TI - Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study UR - http://hdl.handle.net/11427/36504 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/36504 | |
| dc.identifier.vancouvercitation | Adekunle M. Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study. []. ,Faculty of Health Sciences ,Department of Paediatrics and Child Health, 2022 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/36504 | en_ZA |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Paediatrics and Child Health | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.subject | Haematology-Oncology | |
| dc.title | Prevalence, Risk Factors and Predictors of Adverse Outcomes of Febrile Neutropenia in Oncology Patients on Chemotherapy at the Red Cross War Memorial Children's Hospital: A Three Year Retrospective Study | |
| dc.type | Master Thesis | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MPhil |