Febrile Neutropenia in Patients Undergoing Chemotherapy: A Systematic Review

Abstract

Background: Febrile neutropenia (FN) remains one of the most serious complications of chemotherapy, contributing significantly to morbidity, mortality, treatment interruption, and healthcare burden.
Objective: To systematically review the epidemiology, risk factors, clinical outcomes, diagnostic approaches, and management strategies for febrile neutropenia (FN) in cancer patients receiving chemotherapy.
Methods: A systematic search of PubMed, Scopus, Embase, Web of Science, CINAHL, and Cochrane Library was conducted from January 2010 to December 2024. Studies focusing on adult or paediatric chemotherapy-induced febrile neutropenia were included. PRISMA 2020 guidelines were strictly followed. Data were synthesized narratively and tabulated.
Results: A total of 4,316 records were identified; 62 studies were included. The pooled incidence of FN ranged from 8–38% depending on cancer type and chemotherapy regimen. Major risk factors included advanced age, hematological malignancies, multi-agent chemotherapy, poor nutritional status, and low baseline absolute neutrophil count (ANC). Prompt empiric broad-spectrum antibiotics reduced mortality by 10–21%. G-CSF prophylaxis reduced FN incidence by up to 45%.
Conclusion: FN remains a preventable yet life-threatening emergency. Early risk stratification, standardized diagnostic protocols, timely empiric antimicrobial therapy, and use of G-CSF for high-risk patients significantly reduce mortality.