Mismanaged Oral Cancer Leads to Neutropenia and Death

This case involves a fifty-nine-year-old man who was diagnosed with squamous cell carcinoma of the mouth and tongue. The cancer was stage III at the time of diagnosis and the oncologist on the patient’s case sought the input from several other doctors to help manage the patient’s care. The plan was for the patient to have the remainder of his teeth extracted prior to beginning chemotherapy and external beam radiation. The doctors involved were a medical oncologist, a radiation oncologist, a dentist, and an oral surgeon. The patient’s teeth were extracted and he was admitted to the hospital that day to begin the chemotherapy. He was hospitalized for five days to receive the treatment and was then discharged home to recover. Two days later, he was re-hospitalized for severe neutropenia and died shortly after as a result of being severely immunocompromised.

Question(s) For Expert Witness

1. Could prophylactic antibiotics have changed the outcome of this case?

Expert Witness Response E-000029

Medical care for patients with neutropenia is mostly supportive and based on the etiology, severity, and duration of the neutropenia. Fever and infections occurring as complications of chemotherapy induced neutropenia require specific treatment. It is important to promptly start prophylactic antibiotic therapy to combat potential infections in the immunocompromised state. This often involves the use of third-generation cephalosporins or equivalents and I suspect that this patient died from a lack of preemptive treatment.