Oak House

Moorhead Way

Bramley

Rotherham S66 1YY

Please ask for: Lesley Tweed (01709 302712)

Our ref: RHITS/FOI/Rel/PCT432

[email address]

Dear Sir

Re: Request under the Freedom of Information Act 2000

Further to your recent application for information in accordance with the Freedom of Information Act 2000, I now enclose the relevant information.

Response

Febrile Neutropenia

Background

Fever during neutropenia (FN; 7 Chap. 4.2) is a common side effect after myelosuppressive chemotherapy or radiotherapy; the incidence correlates directly with length and severity of the neutropenia.

Up to 15% of patients with febrile neutropenia develop severe sepsis or septic shock.

Risk factors → neutropenia → febrile neutropenia → sepsis

Via: http://www.springerlink.com/content/wp074w51838376h2/fulltext.pdf?page=1

The significance of neutropenia and febrile neutropenia

Neutropenia

Neutropenia is the reduction in blood neutrophils caused by the non-specific cytotoxic action of cytotoxic agents like docetaxel on the neutrophil producing cells in the bone marrow. Reduction in neutrophil numbers, which is expected with any use of cytotoxic chemotherapy, predisposes patients to infection.

Febrile neutropenia

Patients with profound neutropenia (absolute neutrophil count <0.5 x 109/L) who develop fever or other symptoms of infection are at serious risk of overwhelming sepsis. Standard treatment is admission to hospital for intravenous broad-spectrum antibiotics (Innes et al 2005). Granulocyte-colony stimulating factor (G-CSF) is also often administered to speed neutrophil recovery.

Via: http://www.nice.org.uk/nicemedia/pdf/LungCancerErlotinibManuRoche.pdf

Data

NHS Rotherham can only determine the number of people admitted to hospital diagnosed with “Agranulocytosis” (which includes “Neutropenia”) or “Transient Neonatal Neutropenia”, not “the number diagnosed with Febrile Neutropenia”.

This is because hospital episode data (used to determine the above) is coded using the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Within this, there is no definitive code for “Febrile Neutropenia”, only “Agranulocytosis” which includes “Neutropenia”. This is coded as ICD-10: D70. Additionally, there is “Transient Neonatal Neutropenia”, coded as ICD-10: P61.5

During 2008* there were 19 people resident in Rotherham admitted to hospital diagnosed with Agranulocytosis or Transient Neonatal Neutropenia. However, there may be other people in the community diagnosed with (Febrile) Neutropenia who weren't admitted to hospital (e.g. diagnosed at outpatients)

In terms of deaths to Rotherham residents during 2008*, there were 6 deaths mentioning “Neutropenia” or “Neutropenia Sepsis” (all coded as ICD-10: D70) within the 8 Cause of Death fields (used to denote “all those diseases, morbid conditions or injuries which either resulted in or contributed to death”). Only 1 death had Neutropenia classed as the underlying cause of death.

Sources

Hospital Episode Dataset via Secondary Uses Service.

Public Health Mortality Files, Office for National Statistics.

Notes

*Data for 2008 may not be complete.

If you are not satisfied with our response, you have the right to appeal and can write to `The Health Advice Centre' using the following details.

PALS Coordinator,

Health Advice Centre,

RAIN Building,

Eastwood Lane,

Rotherham S65 1EQ

Telephone: (01709) 302481

E-mail: [email address]

The Health Advice Centre will deal with any initial complaint or concern in an informal manner. If a complaint cannot be dealt with satisfactorily on an informal basis, the Health Advice Centre will inform you about its internal complaints procedure, and also how to contact the Information Commissioner if you wish to do so. The Health Advice Centre will also explain that although you cannot apply to the Commissioner for a decision until the Trust's Complaints Procedure has been exhausted, the Commissioner might investigate the matter at his or her discretion.

All complaints at this stage will normally be dealt with within 28 days. '

If you require any further information, please do not hesitate to contact the Information Governance Department.

Yours sincerely

Lesley Tweed

IT Information Support Officer

Information Governance Department