MASCC Score Calculator — Febrile Neutropenia Risk & Outpatient Suitability

How to Use This Calculator

1. Select the burden of illness level (no/mild, moderate, or severe/moribund).
2. Answer Yes/No for each of the remaining 6 criteria.
3. MASCC score, risk classification, and management recommendation display instantly.
4. Use the Outpatient Exclusions tab to check absolute contraindications to outpatient therapy.
5. Professional tier adds ANC duration context.

Formula

Example

Frequently Asked Questions

• What is the MASCC score and when is it used? ▼
  The MASCC (Multinational Association for Supportive Care in Cancer) score is a validated risk index used in oncology to identify patients with febrile neutropenia who are at low risk of serious medical complications and may be candidates for outpatient oral antibiotic therapy rather than hospitalisation. Febrile neutropenia is defined as a temperature above 38.3°C (or above 38°C sustained for one hour) in a patient with an absolute neutrophil count below 0.5×10⁹/L or below 1.0×10⁹/L predicted to fall below 0.5. The MASCC score was developed by the Multinational Association for Supportive Care in Cancer and published in 2000, validated in over 1,000 patients across 17 countries. A score of 21 or above indicates low risk, with a serious complication rate of approximately 6%; a score below 21 indicates high risk with a serious complication rate around 39%.
• How is the MASCC score calculated? ▼
  The MASCC score uses seven criteria with weighted points. Burden of illness contributes the most: no or mild symptoms earn 5 points, moderate symptoms earn 3 points, and severe symptoms or moribund status earns 0 points. Additional criteria, each contributing fixed points when present, are: no hypotension (systolic BP 90 mmHg or above) adds 5; no COPD adds 4; solid tumour or no prior fungal infection adds 4; no dehydration requiring IV fluids adds 3; outpatient status at onset of fever adds 3; and age below 60 adds 2. The maximum possible score is 26. A total score of 21 or above classifies the patient as low risk for serious complications, potentially suitable for outpatient oral antibiotic management. Note that the burden of illness score requires careful clinical assessment and is the most subjective component.
• What are the absolute exclusion criteria for outpatient management even with MASCC ≥21? ▼
  Even when the MASCC score is 21 or above (low risk), several clinical factors contraindicate outpatient management. These include: inability to take or absorb oral medications due to nausea, vomiting, mucositis, or malabsorption; lack of adequate social support or inability to return quickly to hospital if needed; poor compliance or inability to follow instructions reliably; geographic distance from a medical centre with 24-hour access; active severe infection such as pneumonia, cellulitis, or line infection requiring IV treatment; haematopoietic stem cell transplant recipients; certain haematological malignancies with expected prolonged or profound neutropenia; hepatic or renal impairment affecting antibiotic dosing; and any clinician or patient concern. Patient preference and institutional protocols should also guide the decision.
• Which antibiotics are used for low-risk febrile neutropenia? ▼
  For MASCC low-risk febrile neutropenia (score 21 or above) managed as outpatients, oral fluoroquinolone-based regimens are preferred. The IDSA and ASCO guidelines recommend ciprofloxacin plus amoxicillin-clavulanate (to provide anaerobic and streptococcal coverage) as first-line. Moxifloxacin monotherapy is an alternative with broader gram-positive coverage. Levofloxacin monotherapy is also used at some institutions. Patients should be re-evaluated clinically within 24–48 hours. If fever persists or worsens, or if the patient deteriorates, admission for IV antibiotics is required. For inpatient high-risk febrile neutropenia (MASCC below 21), IV piperacillin-tazobactam, cefepime, or meropenem are first-line. Empiric antifungal therapy (liposomal amphotericin B or an echinocandin) is added if fever persists for 4–7 days without a defined bacterial source.
• What is the CISNE score and how does it compare to MASCC? ▼
  The CISNE (Clinical Index of Stable Febrile Neutropenia) score was developed specifically to identify outpatient-suitable febrile neutropenic patients among those who appear clinically stable — addressing a limitation of MASCC, which tends to classify many stable patients as low risk without distinguishing those with occult serious complications. Published by Carmona-Bayonas et al. in 2015, CISNE uses six criteria including ECOG performance status, hyperglycaemia, COPD, NCI grade 2 mucositis, monocyte count, and cardiovascular disease, each with specific point values. A CISNE score of 0 (low risk) is associated with a serious complication rate under 2%, better than MASCC alone. Some guidelines now recommend CISNE as a complementary tool to MASCC for stable-appearing patients, particularly when the concern is identifying hidden high-risk patients within the clinically stable group.

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