Support Care Cancer (2012) 20:3029–3030 DOI 10.1007/s00520-012-1616-3

LETTER TO THE EDITOR

Are neutropenic patients at an increased risk of infection? Jecko Thachil

Received: 22 August 2012 / Accepted: 24 September 2012 / Published online: 3 October 2012 # Springer-Verlag Berlin Heidelberg 2012

Oncologists are familiar with neutropenia and patients with neutropenia. We are not concerned when the absolute neutrophil count is only marginally lower than the normal range unlike other specialists including rheumatologists or solid organ transplant physicians, who may worry with counts less than 1.5 ×109/L. At the same time, we may worry ourselves and our patients when the count is below 0.5× 109/L and certainly below 0.2×109/L. Until recently, the trend has been to keep such patients in hospital side rooms or keep a close eye on them, even if they are discharged, with frequent blood tests and granulocyte colonystimulating factor injections. But is this the right practice? It is well established that neutrophils are key components of the immune system and are the principal mediators of primary immune strategy. At the same time, if the patient does not have any infection, neutrophils have not been demonstrated to play a role in maintaining the health of the individual. In these circumstances, it may be necessary to ask, should we giving advices like—‘you are at an increased risk of infection’ or ‘you are likely to pick up infections very easily’? It is not uncommonly that you hear this useful advice delivered from the oncology wards or the bone marrow transplant units. Many of the hospital protocols and patient guides have incorporated this piece of information. And it is considered the ‘duty’ of oncologists and the specialist nurses to remind patients about their increased infection risk based on the neutrophil count and document these in the notes. These have led to, at least in

J. Thachil (*) Department of Haematology, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, UK M13 9WL e-mail: [email protected]

my experience, severe restrictions in patients’ physical, social and psychological well-being. Many severely neutropenic patients are confined to their houses (or their ward rooms) with little, if possible, allowances to undertake any physical activity and exposure to sunlight which may decrease the likelihood of complications (at least marginally). Good physical activity is well known to help in gut motility, which is of great help in those who are receiving or have received chemotherapy and lessen the likelihood of gastrointestinal problems [1]. Physical exercise also reduces the chances of respiratory infections by allowing good lung excursions [2]. Increased blood flow and muscle activity may also decrease the likelihood of thromboembolic episodes, which can complicate the management of these patients. In addition to the effects on the physical health, home confinement can obviously have an impact on the psychological well-being of such individuals [3]. Sun exposure has been linked to reduced likelihood of depression with a role for vitamin D postulated in these situations [4]. Maintaining the routine daily life pattern prior to the onset of illness may also help in achieving normality in the oncology patients. As such, although we should be actively discouraging the neutropenic individuals from mingling with those who may have infections, we should be less stringent on the restrictions we wrongly impose on their daily lifestyle. It is important NOT to say that ‘neutropenia is a risk for infections’ but to get it right by stressing ‘if you get an infection, when you are neutropenic, you should seek urgent medical help’.

Conflict of interest I do not have any financial relationships with any organisation that sponsor research or authorship. I have full control of all primary data and agree to allow the journal to review their data if requested.

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Support Care Cancer (2012) 20:3029–3030 symptoms in patients with chronic heart failure: the HF-ACTION randomized trial. JAMA 308:465–474 3. Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE et al (2011) Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist 16:112–120 4. Pearce SH, Cheetham TD (2010) Diagnosis and management of vitamin D deficiency. BMJ 340:b5664