ADVANCE: Suspected chemotherapy-related neutropenic sepsis.
Research type
Research Study
Full title
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.
IRAS ID
252236
Contact name
Sarah Townsend
Contact email
Sponsor organisation
Velindre University NHS Trust
Clinicaltrials.gov Identifier
746, CTR Portfolio Database Number; 2018/VCC/078, Sponsor Reference Number; TIG2017-13, Tenovus Funder Reference Number; 2018/18, Velindre Charitable Funds Reference Number
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary
This study aims to improve pathways for cancer patients with suspected chemotherapy-related neutropenic sepsis. Under current UK NICE guidelines chemotherapy patients take their temperature if they feel unwell and if, following telephone triage, the clinic suspects neutropenic sepsis the patient attends hospital to undergo assessment including a routine blood test. If this test reveals low anti-infection cells (white cells) they are hospitalised and receive antibiotics by drip. The same routine blood test is also used in a routine pre-chemotherapy safety assessment to determine if chemotherapy patients are well enough to start or continue receiving each new cycle of chemotherapy.\nWe wish to find out if a new diagnostic test, the Hemocue WCB Diff System which takes 5 minutes using one drop of blood, can be used instead. This study will explore accuracy and safety of the new test as an aid to the decision-making process in two patient cohorts: 1) patient on chemotherapy who are admitted to hospital outside of normal clinic hours with suspected neutropenic sepsis; 2) patients on chemotherapy treatment identified as having borderline neutropenia and requiring a repeat test to assess if they are well enough to start or continue chemotherapy.\nThe study will also investigate acceptablity of using the new test to patients, carers and health care workers via discussion group meetings and a patient questionnaire, and overall benefit to patients including improvement of patient choice and control and independence in relation to their illness. \nIf successful we will develop a separately funded, larger clinical trial to explore the overall benefit and economic impact of the new equipment in the wider UK setting.\n
Summary of Results
Investigation of a point of care white cell count test to improve pathways for cancer patients with low white cell counts and possible sepsis whilst receiving chemotherapy in a cancer specialist hospital: a pilot study.
Results: 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:
Acute admissions for neutropenic sepsis: 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.
Public-facing final funding report available at:
https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fwww.tenovuscancercare.org.uk%252Fresearch-listings%252Fcommunity-based-point-of-care-poc-white-cell-count-testing-to-improve-pathways-for-cancer-patients-with-sepsis-whilst-receiving-chemotherapy-a-pilot-study%2FNBTI%2FuMu3AQ%2FAQ%2F78326237-ea2a-4103-9195-60fd0470339c%2F3%2F8q2bUuRRy-&data=05%7C02%7CWales.REC3%40wales.nhs.uk%7Cab74786bf28c4581ee0408dcd2488779%7Cbb5628b8e3284082a856433c9edc8fae%7C0%7C0%7C638616456176251986%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=Q1aXu1IYBaFXrOGeGGjDBnAXNZjR2OJ6P2dnimHXCO8%3D&reserved=0Study and results summaries publicly available at:
1) https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fwww.cancerresearchuk.org%252Fabout-cancer%252Ffind-a-clinical-trial%252Fa-study-to-find-out-if-a-new-device-can-improve-the-management-of-people-with-borderline-sepsis%2523undefined%2FNBTI%2FuMu3AQ%2FAQ%2F78326237-ea2a-4103-9195-60fd0470339c%2F4%2F2gRTsWlwe1%23undefined&data=05%7C02%7CWales.REC3%40wales.nhs.uk%7Cab74786bf28c4581ee0408dcd2488779%7Cbb5628b8e3284082a856433c9edc8fae%7C0%7C0%7C638616456176261523%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=aUKyMr4eudQPWOMmOs44fHosw2jQZYdD2e4UEEauOWw%3D&reserved=0
2) https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fwww.cardiff.ac.uk%252Fcentre-for-trials-research%252Fresearch%252Fstudies-and-trials%252Fview%252FADVANCE%2FNBTI%2FuMu3AQ%2FAQ%2F78326237-ea2a-4103-9195-60fd0470339c%2F2%2FBs3NcXQ1EA&data=05%7C02%7CWales.REC3%40wales.nhs.uk%7Cab74786bf28c4581ee0408dcd2488779%7Cbb5628b8e3284082a856433c9edc8fae%7C0%7C0%7C638616456176269965%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=n7%2BsHwhUXolDrazLC%2FAwwowl2U775nlfDq00tE3kw4o%3D&reserved=0REC name
Wales REC 3
REC reference
19/WA/0283
Date of REC Opinion
13 Jan 2020
REC opinion
Further Information Favourable Opinion