Febrile neutropenia - when fever occurs in a patient with a weakened immune system and may signal life-threatening sepsis - is the commonest life-threatening complication of treatment for children with cancer. Although the majority of children have no significant complications associated with its occurrence, current management includes intravenous antibiotics and in-patient care.
During the Covid-19 pandemic, health services have been under immense strain trying to balance routine treatments with additional patients and the introduction of new safety measures. Safety restrictions have meant children undergoing cancer treatment can only see one parent and no other visitors which can be distressing.
Finding ways to manage febrile neutropenia which shortens hospital stays for children with cancer not only reduces demand on the National Health Service but also maximises the quality of life for the children and their families.
The national children’s cancer community - including experts at the University of York - looked for ways to reduce the duration of hospitalisation for immunosuppressed children and young adults.
Funded by the National Institute for Health Research, Candlelighters (the Yorkshire Children’s Cancer Charity), and the Medical Research Council, researchers explored the effectiveness of reduced therapy regimes for children. This involved using objective and subjective data to assign risk levels to patients to guide care management decisions. This was combined with qualitative research conducted by Candlelighters exploring the acceptability and barriers to implementation presented by parents and carers and those affected by the scheme.
The research suggested the use of shorter duration and less intensive (oral) antibiotics in patients undergoing cancer treatment and with a lower risk of severe complications would be safe. This global collaborative, building on work undertaken in York and Australia, tested the risk stratification rule - a technique for categorising patients based on their health status and other factors - and validated it for the UK population.
The team also developed a programme to support hospitals undertaking the risk stratification process and supported a national audit of its introduction.
The research has led to an important reduction in the amount of time some children need to spend in hospital, and a better quality of life for themselves and their families.