A new tool for the prediction of complications associated with febrile neutropenia

April 28th, 2016 in Reflection

Authors: Matthew Fowler, RN, B (Nurs) PGDip

Affiliations: Heart of England NHS Foundation Trust

This piece of work is adapted from an original article submitted by Matthew Fowler as follows:

Fowler, M., (2015) Management of Patients with Low-Risk Febrile Neutropenia. Cancer Nursing Practice, 14, (5), pp16-21.

Anti-cancer chemotherapy is well documented to cause a plethora of toxicities, however by far one of the most serious complications is that of febrile neutropenia (Innes et al 2003). As a practising ANP (Advanced Nurse Practitioner) for oncology and haematology I am frequently involved with the care and management of patients presenting with febrile neutropenia and was curious as to if length of stay could be reduced for this group of patients.

The NICE guidelines (2012) advocate that patients classified as Low Risk Febrile Neutropenia (LRFN) should be considered for management in the community setting and the tool most widely utilised to identify LRFN patients is the Multinational Association of Supportive Care of Cancer (MASCC) Risk Index which was devised by Klastersky et al (2000) and is demonstrated in Table 1 below

Teuffel et al (2010) have also identified a cohort of patients identified as LRFN in accordance with the MASCC risk index who unfortunately go on to develop complications necessitating hospital admission; this further substantiates the case for initial admission to hospital for a period of observation for LRFN patients. In response to some of the concerns raised about the MASCC risk index, Carmona-Bayonas et al (2011) devised the CISNE (Clinical Index of Stable Febrile Neutropenia) (see Table 2) tool to identify patients who are at low risk of developing complications of FN who can be discharged home after 24 hours if their CISNE score is 0.

Table 2 CISNE tool (Carmona-Bayonas et al 2011)

Characteristic Score
Performance Status >2 2
Stress Induced Hyperglycaemia 2
Chronic cardiovascular disease 1
Mucositis grade >2 1
Monocytes <0.2 1


Use of the CISNE tool has the potential to revolutionise the way in which patients with LRFN are cared for. There is potential for patients with LRFN to be discharged home after 24 hours with oral antibiotics and robust patient education. In my own area of practice, I am in the process of working with the consultant microbiologists, general physicians and oncologists to devise a robust pathway for early discharge of patients with LRFN using the CISNE tool.

This clearly has fundamental and far-reaching implications for both the healthcare economy and most importantly the cancer patient journey. This is the beginning of an exciting development and it is proposed that once this change in practice is embedded that we can begin researching a truly ambulatory model for management of patients with LRFN.


Carmona-Bayonas, A., Gomez, J., Gonzalez-Billalabeitia, E., Canteras, M., Navarrete, A., Gonzalvez, M. L., Vicente, V. and Ayala de la Pena, F. (2011) Prognostic evaluation of febrile neutropenia in apparently stable adult cancer patients. British Journal of Cancer, 105 (5): 612-617.

Innes, H.E., Smith, D.B., O’Reilly, S.M., Clark, P.I., Kelly, V. & Marshall, E. (2003) Oral antibiotics with early hospital discharge compared with in-patient intravenous antibiotics for low-risk febrile neutropenia in patients with cancer: a prospective randomised controlled single centre study. British Journal of Cancer, 89 (1): 43-49.

Klastersky, J., Paesmans, M., Rubenstein, E. B., Boyer, M., Elting, L., Feld, R., Gallagher, J., Herrstedt, J., Rapoport, B., Rolston, K., and Talcott, J. (2000) The Multinational Association for Supportive Care in Cancer Risk Index: A Multinational Scoring System for Identifying Low-Risk Febrile Neutropenic Cancer Patients. Journal of Clinical Oncology, 18 (16): 3038-3051.

National Institute for Health and Care Excellence (2012) Neutropenic Sepsis: prevention and management of neutropenic sepsis in cancer patients (CG51) London: National Institute for Health and Care Excellence.

Teuffel, O., Amir, E., Sung, L. & Alibhai, S. M. (2010) Treatment strategies for low-risk febrile neutropenia in adult cancer patients: A cost-utility analysis. (2010) Journal of Clinical Oncology, 28:15s, (suppl; abstr 6102)



2016 Award Winners Announced

April 14th, 2016 in Board in Action

The International Society of Nurses in Cancer Care (ISNCC) is honored to announce its award winners for 2016. The winners will be presented their awards at the International Conference on Cancer Nursing (ICCN) 2016, September 4-7, 2016 in Hong Kong, China.

ISNCC also thanks all those who submitted nominations.

Distinguished Merit Award – Sanchia Aranda


The Distinguished Merit Award is offered once every two years in recognition of an outstanding contribution to the international advancement of the science and art of cancer nursing, if warranted. ISNCC is pleased to announce Sanchia Aranda as this year’s winner of the Distinguished Merit Award.

Professor Sanchia Aranda is the CEO of Cancer Council Australia. She has more than 30 years’ experience in cancer control as a clinician, researcher, educator and senior healthcare administrator. From her early career as a Registered Nurse in New Zealand she specialized in cancer and palliative care, completing a Bachelor of Applied Science, a Master of Nursing and a doctoral thesis exploring nurse-patient relationships in cancer and palliative care. She has extensive experience in health-system administration and most recently was Director of Cancer Services and Information and Deputy CEO at the Cancer Institute NSW.

Professor Aranda is President-Elect of the Union for International Cancer Control (UICC) and a former President of ISNCC. As well as being a research fellow at the Peter MacCallum Cancer Centre, she holds academic appointments at the School of Health Sciences, University of Melbourne, and the Faculty of Nursing, University of Sydney.

Widely published in Australian and international health literature, Professor Aranda has also conducted research reviews for the National Health and Medical Research Council, Australian Research Council, Cancer Councils, state nursing boards and private sector research funding bodies. As CEO of Australia’s top non-government cancer control organization, Professor Aranda is a strong independent voice on evidence-based cancer control. She is engaged in all fields of cancer from primary prevention through to survivorship and advanced care, and has a particular professional interest in improved ways to care for and support cancer patients. She is also a regular commentator on cancer issues in Australian media.

Professor Aranda’s role in cancer control has been recognized nationally and internationally, and in 2013 she was named the 4th Peter MacCallum Cancer Centre Distinguished Fellow for her contributions to cancer nursing.

The Distinguished Merit award will be presented by the ISNCC President to Professor Aranda at the ICCN 2016 in Hong Kong, China, during the Distinguished Merit Award Session on Tuesday September 6, 2016 at 4.40pm – 5.30pm. Professor Aranda will present a 30 minute lecture on the awarded activities.

Past Presidents’ Award – Naomi Oyoe Ohene Oti

Naomi Ohene Oti

This award was given for the first time at the biennial conference of the ISNCC in the year 2000. It is given in recognition of a cancer nurse from a low or middle income country who has initiated and sustained a program of cancer care in her/his country which has been in place for three or more years and has the potential for replication or adaptation beyond the country’s borders. ISNCC is pleased to announce Naomi Oyoe Ohene Oti as this year’s winner of the Past Presidents’ Award.

Naomi has been working in the field of oncology for the past fourteen years. She leads oncology nursing training at the National Centre for Radiotherapy and Nuclear Medicine in Korle Bu, Ghana. She has been pivotal in oncology nursing education at her facility and in Ghana. In 2002 Naomi travelled to the Mayo Clinic in the USA where she was trained in the coordination of clinical trials. In this role, she identified and learned the critical role of the oncology nurse and its impact on delivery of quality care to cancer patients. The Mayo program inspired her to pursue formal training in oncology. Naomi used her training to institute a variety of in-house training programs that have enabled nurses to deliver quality cancer care. Naomi is now the focal person for oncology nursing training for Ghana’s Ministry of Health. In 2014 and 2015 she was among a team of specialists who developed the Postgraduate Clinical Oncology Nurse Specialist curriculum for the Ghana College of Nurses and Midwives. Naomi was also a recipient of an ISNCC conference scholarship to 13th ICCN 2004 in Sydney, Australia.

The Past Presidents’ Award will be presented by the ISNCC Immediate Past President at ICCN 2016 in Hong Kong, China, during the Closing Address on Wednesday September 7, 2016 at 3.00pm – 3.30pm

Robert Tiffany Lectureship 
This lectureship was created to keep alive and honor the memory of Robert Tiffany, founding member and President of the International Society of Nurses in Cancer Care. Robert Tiffany was the initiator of the Biennial International Conference on Cancer Nursing. Robert Tiffany was an inspiration to many nurses around the world and the intention of the named lecture is to honor those who have a similar capacity to inspire cancer nurses of today and of the future.

ISNCC is pleased to announce Myrna McLaughlin-Anderson as this year’s winner of the Robert Tiffany Lectureship.

Myrna McLaughlin de Anderson Photo

Myrna is a Senior Advisor in the Panama Ministry of Health and has almost thirty years of experience in cancer nursing. She is also a Professor of Nursing at the University of Panama, where she teach several courses pre-graduate and post-graduate courses in the School of Nursing including Adult Health, Cancer Prevention and Epidemiology, Chemotherapy and Palliative care. In 2008, she the received ISNCC’s Past Presidents’ Award in recognition of the development of Asociacion HOSPES Pro-cuidado Paliativo, a Palliative Care program in Panama. From 2009-2011, Myrna was as the advisor to the Vice-Minister of Health. From that position, she was an integral component of the commission that developed the National Program of Palliative care and the National Plan for Cancer Prevention and Control. In 2013, the Mayor of the City of Panama awarded Myrna the Key of the City in recognition of her career treating cancer patients and promoting cancer nursing education.

The Robert Tiffany Lectureship will be held at the ICCN 2016 in Hong Kong, China on Monday September 5, 2016 at 8.25am – 9.00am during the Official Opening & Keynote session. The Robert Tiffany Lectureship recipient will be invited to present a 40 minute lecture as outlined above.

Improve quality of care for better patient outcomes: Joint efforts of Oncology Nursing Committee of Chinese Nursing Association and Chinese Anti-Cancer Association

April 1st, 2016 in Conference Features

Authors: Bo Xu, Yong-yi Chen, Xiang-hua Xu

Affiliations: Oncology Nursing Committee of Chinese Nursing Association

The Second Asian Oncology Nursing Society (AONS) Conference was held on 19-20 November 2015 at Seoul St. Mary’s Hospital, The Catholic University of Korea. The conference theme was ‘Flying the spirit of Asian Oncology Nursing’. In order to support this important conference for cancer nurses, the Oncology Nursing Committee of Chinese Nursing Association and the Oncology Nursing Committee of Chinese Anti-Cancer Association jointly organized a conference workshop. The workshop consisted of three sessions: a healthcare delivery model adopted in a chemotherapy day center, nursing management for patients receiving oral chemotherapy, and management of early sign of thrombosis associated with peripherally inserted central catheters (PICC). The speakers shared with the participants about up-to-date research reports and health needs of Chinese patients undergoing chemotherapy and those with PICC. They also shared their experience of clinical practice and how to improve quality of care and patient outcomes. Enthusiasm of the participants was noted by their active participation in the discussion. The participants also found that the workshop was useful of improving their clinical practice and promoting quality of care. The joint efforts of the Oncology Nursing Committee of Chinese Nursing Association and Chinese Anti-Cancer Association in organizing this conference workshop would be continued to support AONS in professional development of oncology nurses in Asia.




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