ADVANCE

A community-based point of care white cell count device to improve critical care pathways for cancer patients with suspected chemotherapy related neutropenic sepsis: a feasibility study

Background

ADVANCE was a pilot (feasibility) study aimed at improving pathways for cancer patients with sepsis whilst receiving chemotherapy. Patients receiving chemotherapy as a part of their cancer treatment often have a lowered immunity and may be unable to fight off infections. This can mean that they are at risk of serious illness or death. The ability to monitor patients who have received hospital-based chemotherapy in their own home may help more quickly identify those patients at high risk or minimal risk from neutropenic sepsis.

Testing new technology

Following UK National Institute for Health and Care Excellence (NICE) guidelines, UK cancer centres instruct patients on chemotherapy to take their temperature if they feel unwell, and to report this to the centre as soon as possible. These patients then attend hospital and undergo assessment including a blood test. If their blood test reveals that their anti-infection cells (white cells) are low they will need to stay in hospital to receive antibiotics as a drip treatment. We wanted to find out if a new piece of equipment (Sight Diagnostics OLO System – a 60 second laboratory-based blood test requiring one drop of blood) can prevent patients from being admitted to hospital unnecessarily by ruling out a low white cell count.

Scope of study

This research explored:

• the acceptability of using the Sight Diagnostics OLO System to patients and healthcare professionals
• the safety of using this system in the laboratory as an aid to the decision making processes with the medical team
• the overall benefit to patients, including whether this equipment should be considered for routine use in patients receiving chemotherapy, in order to improve patient choice, control and independence in relation to their illness
• the potential economic impact of this new approach
• how this new approach might be integrated across the UK.

Improving patient outcomes

This study aimed to improve outcomes for patients receiving chemotherapy by:

• preventing wasted journeys, inefficient contacts with the NHS and hospital admissions
• detecting low white blood count early to prevent life threatening complications
• providing reassurance and engagement in the management of patients’ cancer
• avoiding unnecessary assessment of patients with an increased body temperature, but are otherwise well, in hospitals and cancer centres
• identifying patients who need urgent assessment, to improve on delivery times and reduction of risk.

Study team

This study was conducted by a diverse team of collaborators based in North and South Wales (UK), including:

• The Centre for Trials Research at Cardiff University
• Velindre Cancer Centre (Cardiff) Patient Liaison Group facilitated through the Wales Cancer Research Centre and Tenovus
• Velindre NHS Trust Innovation Group

Results

Preliminary findings

The researchers conducted stakeholder meetings with hospital staff, patients and carers. The meetings identified three potential groups of patients meriting further investigation using the OLO point of care test equipment and two areas of focus:

1. Acute admissions for neutropenic sepsis
2. White blood cell count verification at pre-chemotherapy checks

Preliminary findings indicated that the OLO System is not the system of choice for this specific clinical application. However, the concept of using point of care to replace current lab-based methods appears acceptable to stakeholders, and has the potential to reduce door-to-result time, improving patient outcomes and service efficiency.

Data indicated a preference for a finger prick blood collection method, a community-based test location, and a health professional operator. The project highlighted the need for a holistic approach when exploring integration of new technologies into routine NHS services, with a focus on addressing challenges around patient and staff education, staff resource, technology operation flaws, and stakeholder acceptability.

Impact

The results of this study have broad implications for a large patient population and will hopefully pave the way to future studies to explore point of care testing which will include formally exploring the impact of various point of care testing devices in the management of anti-cancer therapies. It is envisaged that if these prove safe, effective and cost effective that this will result in step changes in how patients are managed during their cancer treatment, within Wales and beyond