Comparison of febrile neutropenia episodes and outcomes in Turkish versus refugee children with cancer: A single-center experience

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Febrile neutropenia (FN) is a frequent and potentially life-threatening complication of chemotherapy in pediatric oncology. Refugee and immigrant children are often considered to be at higher risk for adverse infectious outcomes due to socioeconomic disadvantage, substandard living conditions, and language barriers. This study aimed to compare FN episodes and short-term clinical outcomes between refugee/immigrant and Turkish pediatric oncology patients managed within a universal healthcare system. Materials and Methods: This retrospective, single-center study analyzed 50 FN episodes, with one episode included per patient, occurring between May and July 2022 at a tertiary pediatric oncology center. Patients were stratified by residency status as Turkish citizens (n=31) or refugee/immigrant children (n=19), primarily Syrian refugees under temporary protection. Comparative analyses included demographic characteristics, clinical presentation, microbiological findings, treatment characteristics, length of hospital stay (LOS), and socioeconomic parameters. Group comparisons were performed using Chi-square and Mann–Whitney U tests. Results: Refugee families demonstrated significantly greater socioeconomic disadvantage, with 94.7% having household incomes at or below the minimum wage compared with 38.7% of Turkish families (p<0.001). Blood culture positivity was higher among refugee patients (26.3% vs. 3.2%, p=0.024). Despite these differences, no significant between-group differences were observed in length of hospital stay (10.42 days for Turkish vs. 12.05 days for refugee patients, p=0.335), treatment intensity, or antifungal therapy requirements. Short-term FN-related clinical outcomes during hospitalization were comparable between groups. Conclusion: Despite marked socioeconomic and housing disadvantages and higher rates of documented bacteremia, refugee and immigrant children experienced short-term FN outcomes comparable to those of Turkish patients when managed in a standardized inpatient setting. These findings suggest that system-level factors—such as universal healthcare access, centralized tertiary care, standardized FN protocols, and language support—may help mitigate the impact of socioeconomic disparities on acute infectious outcomes. However, these results are limited to hospitalized FN episodes and should not be extrapolated to long-term cancer outcomes or outpatient care settings.

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