Dear Editor

When treating patients with cytotoxic chemotherapy it is essential to educate patients in the need to seek urgent attention with the likelihood of admission if they have symptoms that may indicate neutropenic sepsis or other severe toxicities. It was therefore surprising to see a study concerning the avoidance of acute admission by such patients[1]. It is, however, reassuring to note that only 4% of the control group and 2% of the intervention group had grade 3 “shivering or shaking chills,” that is, symptoms suggestive of sepsis.

This leaves the question of why so many patients were attending an emergency department (ED) or being admitted with the more common symptoms, led by fatigue. It seems that this study needs to be understood in its gepographical context. The centres where the investigators are afilliated seem to be in relatively densely-populated settlements in the south of the Province of Ontario. This may mean that many of the patients were resident some distance from the place where they were treated. Where that venue is readily accessible to patients they can be comfortable accessing the oncology unit and its familiar staff. If it is not, the local ED may be the place where they take their concerns.

It would therfore be helpful in understanding the findings to know how propensity to seek attenton from acute services relates to the travel time between the patient’s residence and the oncology service.

Reference
1] Krzyzanowska MK, Julian JA, Gu C-S. et al, Remote, proactive, telephone based management of toxicity in outpatients during adjuvant or neoadjuvant chemotherapy for early stage breast cancer: pragmatic, cluster randomised trial. BMJ 2021;375:e066588