Oncology Support

IDSA Neutropenic Fever Guidelines

  1. Pathogens causing bloodstream infections in neutropenic patients (Pages e60-e61) - **Gram-positive bacteria**: MSSA/MRSA Streptococcus pneumoniae, Enterococcus species, and coagulase-negative staphylococci.

    - **Gram-negative bacteria**: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and other Enterobacteriaceae, which are often associated with higher rates of severe complications and mortality.

    - **Fungal pathogens**: Such as Candida species and Aspergillus species, which can lead to more complex forms of infection that may require antifungal therapy.

    - In extreme cases, viral pathogens such as Cytomegalovirus (CMV) and herpes viruses can also contribute to complications in neutropenic patients due to their weakened defenses against infections.

  2. Bacterial pathogens with highest mortality in neutropenic patients (Page e67)

  3. Characteristics of the MASCC Risk-Index Score (Pages e63-65)

  4. Diagnosis criteria for febrile neutropenia (Page e61)

  5. Classify and define degrees of neutropenia (Page e61)

  6. Determine therapeutic settings for febrile neutropenia (Pages e57-58, e67-70)

  7. Recommend empirical antibiotic therapy selection/timing (Pages e67-70, e84)

  8. Regimen for penicillin-allergic febrile neutropenic patients (Pages e67-70)

  9. Duration of therapy for unexplained fever (Pages e71-72)

  10. Empirical vs. preemptive antifungal therapy (Pages e75-78)

  11. Role of G-CSF in febrile neutropenia management (Pages e81-82)

  12. Hematological markers for neutropenia resolution (Pages e73-74)

NCCN Myeloid Growth Factors Guidelines

  1. Patient risk factors for febrile neutropenia (Page MGF-2)

  2. G-CSF primary prophylaxis recommendations (Page MGF-1)

  3. Toxicity risks of filgrastim and pegfilgrastim (Page MGF-C)

  4. G-CSF dosing timing (Page MGF-B)

  5. Primary vs. secondary prophylaxis (Page MGF)

  6. Patients for primary prophylaxis against febrile neutropenia (Page MGF)

NCCN Adult Cancer Pain

  1. Non-opioid medications for cancer pain (Pages PAIN-E)

  2. Opioid dosing for naive/tolerant patients (Pages PAIN)

  3. IV to PO morphine/hydromorphone conversion (Page PAIN-G)

  4. Steps for opioid rotation (Page PAIN-G)

  5. Fentanyl patch dosing (Page PAIN-G)

  6. Oral morphine to oral methadone conversion (Page PAIN-G)

Additional Objectives

  1. Preferred opioids for renal insufficiency (Page PAIN-G)

  2. Common adverse effects of opioids and management (Page PAIN-H)

  3. Differences in kinetics of opioid dosage forms (Page PAIN-G)

  4. Advantages of buprenorphine in cancer pain (Page PAIN-G)

  5. Medications for neuropathic pain, bone pain, and mucositis 30-38. Specific management strategies for clinical indications, environmental precautions, treatment plans, and principles of pain management.

Summary of Cancer Pain Management

  • Pain in cancer patients is prevalent at all stages and requires comprehensive management strategies.

  • Baseline pain is chronic, while breakthrough pain occurs suddenly and can superimpose on baseline pain.

Multimodal Approach to Pain Management

  • Investigate the underlying cause and involve patients in the treatment process.

  • Key treatments may include analgesics, chemotherapy, and supportive measures, including psychological support.

General Principles of Cancer Pain Management

  1. Select appropriate analgesics considering patient-related factors.

  2. Choose administration routes based on patient needs.

  3. Determine dosing intervals and calculate total daily usage to adjust doses as needed.

  4. Manage adverse effects proactively.

  5. Include adjuvant analgesics for enhanced pain relief.

  6. Consider opioid rotation when necessary.