Fevers: When Cancer Becomes an Emergency

A fever may not send most people to the doctor’s office. But for a cancer patient, fever, along with weakness and pain, could signal an infection – and may prompt a visit to the emergency room.
When a person’s immune system is compromised because of cancer and its treatments, it’s harder to rebound, even from common illnesses. Some can even become life-threatening.
That’s why you need to take special care if you are undergoing cancer treatment and develop signs of infection, including fever, chills, abdominal pain, and a productive cough.
If this happens, make sure you:

1. Call your oncologist immediately — especially if you have a temperature of 100.5 degrees Fahrenheit or higher
2. Go to an emergency room, if instructed by your oncologist
3. Clearly indicate that you are undergoing cancer treatment

Conditions that may prompt a doctor’s visit

In terms of urgency, some symptoms are more subjective than others in prompting a doctor’s visit. Cancerpatients may want to see their doctor because of pain, weakness, shortness of breath, vomiting and diarrhea.
“If a patient feels like they need to be seen, then they should come in,” says Chris Gaskins, MD, Emergency Medical Director at Cleveland Clinic’s Hillcrest Hospital. “You can’t quantify how bad someone should feel before seeking help.”
But there’s one symptom that indisputably requires a trip to the doctor: fever. All cancer patients undergoing chemotherapy need immediate attention if they have a temperature of 100.5 degrees Fahrenheit or higher.

Fever, the critical symptom

Chemotherapy often leads to a reduced white blood cell count, called neutropenia. This condition causes the patient’s body to be less effective at fighting off infection. Neutropenic fever is common in chemotherapy patients. Fever can indicate infection. And in patients with a weakened immune system, infections need to be treated before they cause greater complications.
“About 5 to 25 percent of patients receiving chemotherapy will get neutropenic fever,” says Omer Koc, MD, hematologist/oncologist at Cleveland Clinic Beachwood Family Health and Surgery Center. “The more aggressive the chemotherapy, the higher the risk. Age and other underlying illnesses also play a role.”

Treating neutropenic fever

According to Dr. Gaskins, any cancer patient with a fever or other emergent condition should call his or her oncologist immediately. The oncologist will determine if the patient should go directly to an emergency room or to the doctor’s office.
Patients who go to an emergency room should clearly indicate that they are undergoing cancer treatment. It will make a difference in how they are triaged.
“A healthy patient with a fever and cough might get a flu swab or throat swab or chest X-ray,” says Dr. Gaskins. “We may give them acetaminophen and send them home to rest. But a cancer patient with the same symptoms will need a more intense evaluation to find the source of their infection.”
He says they’ll keep cancer patients in isolation to prevent exposure to any new infections while they do a culture of their blood and urine to check for bacteria.
“We’ll start them on antibiotics right away until we identify the cause of their fever. We can always stop the antibiotics later if we find they don’t have an infection,” he says.
The important thing, especially for cancer patients with a fever, is to get medical attention right away.
“There is a correlation between outcome and how quickly antibiotics are started,” Dr. Koc says.
— Cancer Care Team, Health.ClevelandClinic.org