Febrile neutropenia research

A project which has led to revised national guidance across the UK and Australia to get children with cancer home from hospital quicker.

As well as improving treatments and outcomes for children with cancer, a key focus of our research has been how to improve quality of life during treatment. Children and young people with cancer can spend lots of time in hospital and this can be upsetting and disruptive for them and their families. A large number of these hospital admissions can be attributed to febrile neutropenia – a fever in a person with low neutrophils.

Because cancer treatment can increase the risk of developing life-threatening infections, standard practice was to admit young patients with a fever to hospital to receive antibiotics for up to seven days. Admitting children to hospital keeps them very safe meaning nearly all severe infections can be cured. But fevers in children with cancer are very common and often don’t indicate an infection. This intensive approach might mean that children with a common cold must stay in hospital for days until their temperature settles. Meanwhile, they may experience the side effects of antibiotics without any benefit.

Candlelighters funded research over 10 years, to help determine which children really needed to stay in hospital with a fever and which could safely go home. Professor Bob Phillips and Dr Jess Morgan conducted the project, examining data from many studies into febrile neutropenia and developing a framework doctors can use to make these decisions confidently. The framework they produced was accepted by doctors across the UK and as far as Australia leading to a change in national guidance around how fevers are treated in children with cancer. Now in instances where it’s safe to send them home early, the average time a child will be in hospital from a fever is two days, with some able to leave after as little as eight hours.

Frequent hospital admissions can have a huge detrimental impact on a young person and their family. As well as being stressful and unpredictable, there may be practical implications like parents missing work, needing to arrange last-minute childcare for siblings, and unplanned travel costs. Thanks to this research, many children in the UK and around the world can spend more time at home with their families and parents can be relieved of additional stresses during an already challenging time. Around half of all children with fevers can now be quickly identified as safe to go home.

And the positive impact of this work isn’t just felt by children and families. Reducing in-patient stays can help the NHS save an estimated £6m per year and minimising antibiotic use is helping to manage antimicrobial resistance.

The outcomes of this research have been very positive for patients and families and it’s important to build on its success. Ultimately, it’s hoped that even more children with febrile neutropenia could be sent home by using a blood test to detect high levels of a molecule called procalcitonin (PCT). A large clinical trial is needed to prove that the blood test could work but securing funding for a trial of this scale can be tricky. Candlelighters has been able to help further by funding a smaller pilot study which proved that medical professionals and families would be willing to take part in the larger trial. Now Professor Phillips and his team can seek funding, equipped with the evidence and credibility from the pilot study.

Thank you to our brilliant supporters who made funding this research project possible. Together you have helped to build a brighter future for children and young people with cancer.