Cancer and Treatment-related Fever

How do people describe fever?

A fever is defined a temperature rise above normal, ranging from a temperature equal to or greater than 100.4 F to 101 F, or as set your healthcare provider’s office. Fever is a very important warning sign in individuals with cancer.

Depending on how long you have fever, and where you are, it can become an emergency.

Most people have a normal body temperature range of 98.0 degrees F-98.6 degrees F by mouth, but can go from 97 to 99.5 (one degree higher rectally).

What causes fever?

Bacteria can enter the blood stream through any entrance to the bloodstream, such as the skin, mucous membranes that line the mouth and gastrointestinal tract.

The immune system attacks bacteria in the blood and releases substances causing the brain to raise the core body temperature.

It is estimated that over 30% of individuals with cancer will develop a fever sometime during the course of their illness.

Fever can be due to infection (80%) or tumor (20%). These causes include infection, drugs, cancer treatment, blood transfusion reactions and autoimmune problems.

Certain chemotherapy drugs such as asparaginase, belomycin, dacarbazine, and gemcitabine can cause fever. Most biotherapy drugs such as interleukin-1, interferons and tumor necrosis factor can also cause fever and other flu-like symptoms.

Neutropenia (low WBC) also can very often cause fever from infection.

How do people cope with fever?

Here are some suggestions to cope with fever:

• Because fever increases your metabolism, eat foods that are packed with proteins and calories, such as peanut butter, vitamin D milk products, carnation instant breakfast.
• Drink 8-10 glasses of fluid to keep hydrated. Fluids can include water, lemonade, lemon-lime soda, popsicles, broth or other soups.
• Try to avoid caffeine, such as coffee, dark cola drinks and Mountain Dew, as caffeine makes you more dehydrated.
• A luke-warm sponge bath or shower can help relieve the discomfort of fever and chills.
• Wash your hands with antibacterial soap often and with extra care, but especially after using the bathroom, blowing your nose, or handling raw meat, fruits or vegetables.
• Take your temperature daily, or as recommended by your healthcare team.
• Avoid contact with crowds or large groups of people.
• Avoid people who you know are sick.
• Air conditioning or a fan can also make you feel more comfortable.
• Try an ice pack wrapped in a towel or washcloth to the body, such as the forehead or under the arms.
• Try to avoid any nicks or cuts by wearing gloves if gardening or washing dishes.
• Call your healthcare provider with any new fever of 100.5 F or above. Write down how long the fever has been present, along with any accompanying symptoms such as chills, shakes, nausea, vomiting, pain when urinating, any reddened or warm area or weeping sores, and report these.
• Avoid taking any Tylenol or aspirin products before talking with your healthcare provider.

What can family members and friends do to help me with my fever?

• Ask family members or friends to prepare high protein and calorie foods.
• Have a family member or friend encourage you to drink fluids throughout the day.
• Have your family member call your doctor’s office when warranted.
• Ask your family member or friend to draw a luke-warm shower or bath.
• Ask family members or friends to help you stay free from an infection by washing their hands, and by asking others who visit to wash their hands.

How can I talk with family members about my fever?

• Tell your family member how the fever makes you feel and is affecting you.
• Ask you family for suggestions to help relieve your fever.

What should I report to my doctor or nurse?

• New fevers of greater than 100.4 F. Make sure when you take your temperature, you haven’t had any hot drinks in the last 10-15 minutes.
• Any fever that is also accompanied by
  • pain on urination
  • shortness of breath
  • cough with yellow or green phlegm
  • a draining sore or wound
  • chills and body aches
  • vaginal discharge
• Your last WBC count, if known.

Where can I get more information?

• Contact your local healthcare provider.
• Call your American Cancer Society at 1-800-ACS-2345, or over the Internet at: http://www. cancer.org. Click on patient symptom information for fever or infection.
• Call the National Cancer Institute at 1-800-4-CANCER, or over the Internet at: http://www.nci.nih.gov, patient information on fever or infection.
• The Oncology Nurses website at: http://cancersourcern.com. Click on patient education.

References:

1. Arnold SM, Patchell R, Lowly AM, and Foon, KA (2001) Paraneoplastic Syndromes, cpt 47 in VT DeVita, S Hellma, SA Rosenberg (Eds) Cancer Principles and Practice of Oncology, 6th Ed Philadelphia, PA: Lippincott Williams and Wilkins.
2. Ezzone, SA (2000) Fever. Chapter 140, in D Camp-Sorrell and RA Hawkins(Eds) Clinical Manual for the Oncology Advanced Practice Nurse. Pittsburgh, PA: Oncology Nursing Press, Inc.