# Use of Scores in Risk Stratification of Febrile Neutropenia—A Scoping Review

## TL;DR

This review looks at how risk scores are used to manage febrile neutropenia in cancer patients and highlights the need for standardized methods.

## Contribution

The study identifies inconsistencies in risk stratification tools for febrile neutropenia and advocates for standardized approaches.

## Key findings

- Current studies on febrile neutropenia risk scores show methodological heterogeneity, making comparisons difficult.
- Most eligible studies focused on validating CISNE and MASCC scores, with some exploring revised MASCC versions.
- Inconsistent definitions and criteria across studies limit the generalizability of risk stratification models.

## Abstract

Febrile neutropenia is a frequent complication in cancer patients undergoing anticancer treatment. Decisions regarding outpatient management are often supported by risk stratification tools. This scoping review examines the utilization of these risk stratification tools. It analyzes their use in the current literature and discusses the pitfalls that validation studies should consider. It concludes that one of the most pertinent differences in the current literature lies in outcomes and inclusion/exclusion criteria, which are often modified to increase predictive performance. These methodological heterogeneities can make comparisons across validation studies particularly difficult. Therefore, a standardized approach to febrile neutropenia risk stratification should be considered to facilitate more reliable comparison and validation.

Purpose: A scoping review of the published risk stratification scores for febrile neutropenia (FN) was performed to provide a basis for further research and optimization of risk stratification models that can support evidence-based clinical decision-making with a combined individual patient and health resource perspective. Methods: The scoping review utilized the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR). Studies reporting risk stratification models for FN and published in the PubMed and/or Scopus databases between 2000 and 2024 were retrieved and reviewed. Study eligibility criteria were adult cancer patients and articles utilizing FN risk stratification methods. Two researchers reviewed all relevant studies separately to determine if they were eligible for inclusion and extracted the necessary data. Results: A total of 210 papers was screened by title and abstract. A further 158 were screened by retrieval and eligibility, and 14 studies were found eligible after reviewing full papers. Studies have different cohort sizes (min 31, max 4434), age and gender distributions, cancer types (1 hematological, 3 gynecological, 10 mixtures of hematological and solid cancers), definitions of FN and complication, study type (2 retrospective, 12 prospective). The resulting papers mostly focused on validating CISNE and MASCC scores. Additionally, they investigated possible improvements by evaluating revised versions of the MASCC score. Conclusions: The scoping review revealed inconsistencies in key definitions when using risk stratification scores. It is concluded that the field could benefit from more consensus in definitions and research approaches to secure the generalizability and utility of the research.