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Leukaemia update. Part 2: managing patients with leukaemia in the community

#### Summary points

Although curative chemotherapy is typically delivered in the inpatient setting, patients are at home for substantial periods of time while they progress through treatment. Patients with chronic leukaemia are usually treated entirely as outpatients. Almost all of these patients will develop complications from their disease or its treatment, and after completing chemotherapy, some patients will experience late complications. A balance between hospital and community based care is vital to optimise treatment efficacy and avoid unnecessary hospital admissions. This article reviews some of the adverse effects of leukaemia chemotherapy that non-specialists should be aware of and considers the longer term problems seen in survivors.

#### Sources and selection criteria

We searched PubMed for clinical trials and the Cochrane Library for meta-analyses. We also sought expert opinion from experienced consultant haematologists. Keywords used were leuk(a)emia, chemotherapy, supportive care, and community care. We also reviewed guidelines from the British Committee for Standards in Haematology and the National Institute for Health and Clinical Excellence.

### Treatment and prevention of infection including neutropenic sepsis

Neutropenic sepsis is a medical emergency, and prompt treatment with intravenous antibiotics is usually life saving.1 Although incidence depends on regimen intensity, all patients on chemotherapy are at risk. Patients may present with non-specific symptoms, rigors, or symptoms associated with the infection site. Patients are advised to contact the acute oncology service available at their local treatment centre, and to monitor …