From the Guidelines
The MASCC score is a crucial risk assessment tool for identifying patients with febrile neutropenia who are at low risk for serious complications, with a score ≥21 indicating low risk, as evidenced by the study published in Clinical Infectious Diseases 1. The MASCC score ranges from 0-26 points and evaluates seven factors, including burden of illness, absence of hypotension, absence of chronic obstructive pulmonary disease, solid tumor or no previous fungal infection, outpatient status at onset of fever, absence of dehydration, and age <60 years. Some key points to consider when using the MASCC score include:
- Burden of febrile neutropenia with no or mild symptoms is assigned a weight of 5 points, while moderate symptoms are assigned 3 points 1.
- Absence of hypotension and absence of chronic obstructive pulmonary disease are assigned weights of 5 and 4 points, respectively 1.
- Patients with scores ≥21 may be candidates for outpatient management with oral antibiotics rather than hospitalization with intravenous antibiotics, potentially reducing healthcare costs and improving quality of life, as supported by the validation study of the MASCC assessment tool 1. However, clinical judgment should always accompany the score, as individual patient factors may necessitate inpatient treatment despite a high MASCC score, and regular reassessment is important as a patient's condition may change rapidly during neutropenic episodes. The use of the MASCC score can help inform decisions about the type of regimen and appropriate venue for delivery of empirical antibiotics, as well as the timing of hospital discharge, as recommended by the Panel 1.
From the Research
MASCC Score Overview
- The Multinational Association for Supportive Care in Cancer (MASCC) score is used to risk stratify patients with febrile neutropenia 2, 3, 4, 5, 6
- The score helps identify low-risk patients who can be managed as outpatients, reducing the need for hospitalization and associated costs 3, 4, 5
Risk Stratification
- A MASCC score of 21 or higher indicates low-risk febrile neutropenia, while a score below 21 indicates high-risk 2, 3, 4, 6
- Studies have shown that low-risk patients identified by the MASCC score have a lower likelihood of complications and mortality compared to high-risk patients 2, 4
Comparison with Other Scoring Systems
- The MASCC score has been compared to the Clinical Index of Stable Febrile Neutropenia (CISNE) score, with the MASCC score showing greater discriminatory power in detecting low-risk patients 3
- However, another study found that the CISNE score was more specific in identifying low-risk patients in the emergency department setting 5
Clinical Application
- The MASCC score can be used in conjunction with clinical judgment to identify patients suitable for outpatient management of febrile neutropenia 3, 5
- Education efforts to incorporate the MASCC score into clinical workflows may help improve patient outcomes by identifying high-risk patients and providing appropriate care 2