MASCC Score

Background

The Multinational Association for Supportive Care in Cancer (MASCC) score identifies patients with febrile neutropenia who are at low risk of serious complications and may be suitable for oral antibiotics or outpatient management. Unusually, a higher score means lower risk. It weights burden of illness, the absence of hypotension, the absence of chronic obstructive pulmonary disease (COPD), having a solid tumour or no previous fungal infection, the absence of dehydration requiring fluids, being an outpatient at fever onset, and age under 60. The maximum score is 26.

Interpreting the result

Because a high score reflects low risk, a score of 21 or more identifies low-risk patients who may be considered for de-escalated care such as oral antibiotics or an outpatient pathway, whereas a score below 21 indicates high risk and the need for admission and intravenous therapy. The threshold is a guide and must always be combined with clinical judgement and local neutropenic-sepsis policy. Importantly, the score informs the setting and route of treatment, never the decision to start antibiotics.

Advice

A score ≥21 indicates low risk. Always combine with clinical judgement and local neutropenic-sepsis policy; never delay antibiotics.

Worked example

A 55-year-old outpatient with a solid tumour, mild symptoms, no hypotension, no COPD and no dehydration: mild symptoms (5) + no hypotension (5) + no COPD (4) + solid tumour (4) + no dehydration (3) + outpatient (3) + age < 60 (2) = 26. This is clearly low risk and may be suitable for an outpatient pathway under local policy.

Pearls / pitfalls

• Remember the score is inverted — a high score means low risk, which is the opposite of most clinical scores.
• A low-risk score never justifies delaying empirical antibiotics; neutropenic sepsis is a medical emergency and antibiotics come first.
• Outpatient management requires more than a score: reliable patient, social support, ready access to hospital and local protocol must all be in place.
• The burden-of-illness item is a subjective clinical judgement, so apply it consistently and cautiously.

Evidence & validation

Derived and validated by Klastersky and colleagues for MASCC, and incorporated into oncology guidance (including ASCO/IDSA and ESMO) as a tool to identify low-risk febrile neutropenia suitable for outpatient or oral therapy in selected patients.

Frequently asked questions

References

1. Klastersky J, Paesmans M, Rubenstein EB, et al. The Multinational Association for Supportive Care in Cancer risk index. J Clin Oncol. 2000;18(16):3038–3051.
2. Taplitz RA, et al. Outpatient Management of Fever and Neutropenia in Adults: ASCO and IDSA Clinical Practice Guideline Update. J Clin Oncol. 2018;36(14):1443–1453.

About the creator

Klastersky J et al.

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