O&G Cases · Gynae-oncology — systemic therapy
Febrile patient on chemotherapy — emergency management station
Emergency-management station: suspected neutropenic sepsis in a patient mid-chemotherapy. Tests recognition of the nadir window, the principle of empirical antibiotics within the hour without waiting for the count, sepsis-six style resuscitation, escalation, and communication with the patient and oncology team. Includes assessor key and marking domains.
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Prompt
A 64-year-old woman on cycle 4 of carboplatin-paclitaxel for stage IIIC ovarian cancer phones the ward at 22:00 with rigors and a temperature of 38.8°C measured at home. She feels cold and shaky but 'not too bad'. Her last chemotherapy was 11 days ago. You are the registrar on call. Manage this from the phone call onwards.
Station brief
A mid-cycle chemotherapy patient phones febrile. The danger is neutropenic sepsis — the nadir window is 7-14 days post-cycle and she is at day 11. You have 12 minutes to triage by phone, manage her on arrival, deliver the empirical-antibiotic bundle within the hour, escalate appropriately, and communicate with the patient and team. [8]
References3ShowHide
- [1]Calvert AH, Newell DR, Gumbrell LA, et al. Carboplatin dosage: prospective evaluation of a simple formula based on renal function J Clin Oncol, 1989.PMID 2681557
- [2]Ozols RF, Bundy BN, Greer BE, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study J Clin Oncol, 2003.PMID 12860964
- [8]Redondo A, Guerra E, Manso L, Martin-Lorente C SEOM clinical guideline in ovarian cancer (2020). Clin Transl Oncol, 2021.PMID 33515422