Influence of patient awareness and health disparities on early identification of neutropenic sepsis risk.
Authors: Emily Kolyvas, Aislinn O'Farrell, Hannah Sanderson, Anna Wilson, Gini Melesi, Mireia Crispin Ortuzar, Saif Ahmad
Journal: Journal of Clinical Oncology (2024)

e13711 Background: Neutropenic sepsis (NS) is a life-threatening condition predominantly affecting immunosuppressed cancer patients undergoing cytotoxic chemotherapy. Recognition of the associated symptoms and swift action in response is critical. Timely administration of antibiotics within the first hour of symptom onset is the gold standard of care, with each hour of delay associated with an 8% rise in mortality. Health disparities further compound this challenge by affecting patient access to healthcare. This study aimed to understand the intricacies of NS awareness amongst patients receiving chemotherapy and their caretakers, and to identify demographic and socioeconomic factors shaping this understanding. Methods: Inclusion criteria included current/prior chemotherapy patient/caregiver, any cancer type, age &gt; 18. Structured interviews were conducted by 52 North (n=15) to obtain qualitative information around NS understanding. In collaboration with the Macmillan Cancer Support, a focused online survey utilizing a 5-point Likert scale was used with 252 respondents in the United Kingdom to date. Participant consent was obtained. Results: Findings from the interviews underscored the relationship between non-adherence to NS guidelines and factors including income, socioeconomic status, and other features impacting behavior. Survey participants included: male:female – 29:219, ages 20-80+ (63.2% 51-70), patient:caregiver – 218:34. Only 160/248 (64.5%) of individuals agreed or strongly agreed that they understood NS while 65/248 (26.2%) disagreed or strongly disagreed and 23/248 (9.2%) were neutral. NS symptoms such as fever were reported by 213/252 (84.5%) of respondents, however only 87/213 (40.8%) sought medical advice in less than 1 hour, 71/213 (33.3%) waited over 1 hour, and 28/213 (13.1%) did not seek advice. Individuals reporting greater NS understanding were more than twice as likely to seek help in less than 1 hour (47.9% vs 19.6%; 68/142 vs 10/51). Individuals with salaries &gt;£40K vs &lt;£40K (~$50K) were more likely to seek help less than 1 hour after symptoms (42.5% vs 36%; 34/80 vs 33/91). Conclusions: This study reveals a compelling association between comprehension of NS and likelihood to seek treatment within the recommended 1-hour timeframe. Furthermore, higher income emerges as a factor influencing the promptness of seeking treatment. These insights highlight the critical issue of delayed care due to a lack of understanding, exacerbated by socioeconomic disparities. This study emphasizes the urgent need for enhanced education targeting at-risk groups. By addressing knowledge gaps and socioeconomic barriers, there exists a tangible opportunity to mitigate NS-related mortality in patients undergoing chemotherapy. Subsequent studies will extend these data to include the United States, to compare analysis of barriers to care in different geographic locations.