Diagnosis of sepsis in people receiving anticancer treatment

Nurses should be able to spot the signs of sepsis in people with neutropenia who are receiving anticancer treatment and immediately refer them for assessment

Earlier this year, the National Institute for Health and Care Excellence (NICE) updated its sepsis guidance.

It encourages nurses to be able to spot the signs and symptoms that indicate a possible infection and to consider more targeted use of antibiotic treatment, prioritising those identified by the National Early Warning Score (NEWS2) as being severely ill or at risk of death.

• RELATED: Sepsis guidance update: what it means for nursing practice

People with neutropenia (low number of white blood cells) who are receiving anticancer treatment are particularly vulnerable to infection and the guidance reminds staff to suspect neutropenic sepsis in people who become unwell and have had systemic anticancer treatment within the last 30 days. They are to refer those patients immediately for assessment.

Greater staff education is recommended to ensure timely management of neutropenic sepsis

In their Cancer Nursing Practice article Neutropenic sepsis: evaluating the timeliness of initial patient management on presentation to hospital, McCauley et al explain the importance of rapidly recognising and treating this life-threatening complication of systemic anticancer therapy.

• RELATED: Neutropenic sepsis: evaluating the timeliness of initial patient management on presentation to hospital

They cite national guidance – that of NICE and the UK Sepsis Trust – recommending that patients with suspected neutropenic sepsis receive antibiotics within an hour of presentation. The authors’ service evaluation at a cancer unit in Northern Ireland uncovered that this target of antibiotic administration was only achieved in 57% of the 37 patients admitted with suspected neutropenic sepsis.

• RELATED: Fear of chemotherapy: how nurses can help cancer patients cope

Their evaluation also demonstrated substandard adherence to guidance such as with recordkeeping, notably regarding patients’ fluid balance. Among their recommendations is greater staff education to ensure the timely management of neutropenic sepsis.

Personalised care and education can alleviate anxiety when people with cancer begin treatment

Infection is just one of the complications that can arise from anticancer treatment so it is hardly surprising people with cancer may feel anxiety or fear about receiving chemotherapy. Roughly one in 300 patients has extreme anxiety about treatment, making sessions traumatic, stressful and even impossible, nurses at The Christie anecdotally reported to health journalist Erin Dean in her analysis on the fear of chemotherapy.

Nurses can help alleviate anxiety when people with cancer begin treatment through personalised care and education, as well as signposting them to counselling and group sessions.

• RELATED: How can nurses help patients report neutropenic sepsis earlier?

Royal Marsden chemotherapy nurse consultant Elaine Tomlins explains that nurses now have a better understanding of the side effects and how to manage them, saying: ‘Sometimes the perception of chemotherapy can be worse than the reality.’

Jennifer Sprinks is editor of Cancer Nursing Practice and co-editor of Nursing Management