Chemotherapy side effects
My Note: Many people are choosing to refuse chemotherapy due to its severe side effects, which can significantly diminish their quality of life. Instead, they are turning to repurposed drugs such as Ivermectin and Fenbendazole, as well as various natural plants, herbs, and supplements, which are gaining support.
What Is Chemotherapy-Induced Anemia and How Is It Treated?
Chemotherapy is a standard treatment for many different types of cancer.
Chemicals in chemotherapy drugs stop cancer cells from growing and spreading. These chemicals can also damage healthy cells, particularly those that divide rapidly. This includes cells in your skin, digestive tracts, and bone marrow.
Damage to these cells can cause side effects. One common side effect is chemotherapy-induced anemia.
Anemia means you don’t have enough red blood cells to properly carry oxygen around your body. This condition develops when chemotherapy drugs damage the cells in your bone marrow that create red blood cells.
Anemia usually goes away once chemotherapy stops, but it can lead to potentially serious complications when it develops. In this article, we break down the causes of chemotherapy-induced anemia, signs and symptoms, and potential complications.
What is chemotherapy-induced anemia?
More than 100 types of medications have been developed to treat cancer, according to the University of Iowa Hospitals and Clinics. Different medications disrupt cancer growth in different ways, and all have potential side effects.
The chemicals in chemotherapy drugs mainly target cells that replicate quickly. Along with cancer cells, these drugs can damage healthy cells. A low red blood cell count caused by these medications is called chemotherapy-induced anemia.
The erythroid progenitor cell is particularly vulnerable to chemotherapy, according to 2018 research. These cells are found in your bone marrow and become red blood cells. If many of these cells are damaged, you can develop a low red blood cell count.
A low red blood cell count means your blood has less hemoglobin than average. Hemoglobin is the protein in red blood cells that carries oxygen to all your bodily tissues.
How common is chemo-induced anemia?
It’s estimated that 70 percent of people who receive chemotherapy develop anemia. It’s most common in people with:
lung cancer
lymphoma
Urinary tract cancers
Reproductive system cancers
At least 50 to 60 percent of people with these cancers require at least one blood transfusion. A transfusion is a procedure where you’re given donated blood through an IV.
Chemotherapy-induced anemia is also common in people with low hemoglobin levels before treatment and people receiving platinum-based chemotherapy medications, according to the American Cancer Society. These medications include:
cisplatin
carboplatin
oxaliplatin
nedaplatin
lobaplatin
What are the signs and symptoms of chemotherapy-induced anemia?
According to 2019 research, signs and symptoms of chemotherapy-induced anemia can overlap with cancer symptoms. These symptoms often include:
fatigue
drowsiness
depression
shortness of breath
Rapid heart rate
dizziness
Other signs and symptoms may include:
lightheadedness
poor concentration
loss of appetite
skin that looks paler than usual
headaches
fainting
How is chemotherapy-induced anemia treated?
Research from 2020 suggests anemia can negatively affect the survival rate of people receiving treatment for cancer. Severe anemia may delay or reduce part of your chemotherapy treatment, which can lead to worse results.
Treatment for anemia may include:
Getting blood transfusions
Taking medications (erythropoietin-stimulating agents)
Supplementing vitamins and minerals that your body needs to create red blood cells
Blood transfusion
A blood transfusion involves receiving blood from a donor through an IV. Donated blood needs to match your blood type, or your immune system may attack the foreign blood cells. Transfusions can help quickly reduce your symptoms by increasing the circulation of oxygen to your organs and tissues.
Transfusions are commonly performed when hemoglobin levels drop below 8.0 grams per deciliter (g/dL) of blood.
Erythropoietin-stimulating agents
A medical professional can administer erythropoietin-stimulating agents as a shot under your skin. They’re synthetic versions of the hormone erythropoietin produced by your kidneys. This hormone stimulates the production of red blood cells.
It usually takes 4 to 6 weeks for these drugs to have a significant effect, and about a third of people don’t respond at all. Healthcare professionals usually only recommend them for people receiving palliative treatment to ease symptoms of anemia when cancer isn’t considered curable, according to 2019 research.
Erythropoietin-stimulating agents can help increase your hemoglobin levels and reduce the need for blood transfusions, but they’re associated with serious health complications and an increased risk of death, according to 2009 research.
Iron and other supplements
About 65 percent of your body’s iron is found in hemoglobin, a protein in your blood that carries oxygen to your body’s organs and tissues. Without enough iron, blood cells can’t carry oxygen to cells throughout your body. Low iron levels can also lead to anemia.
Your doctor may give you a prescription for an iron supplement or tell you to eat more high iron foods, like:
red meats
almonds
broccoli
enriched grains and cereals
beans
Researchers are still investigating the potential benefits of iron supplementation for people receiving erythropoietin-stimulating agents. Research from 2017 suggests that it may help reduce the need for blood transfusions.
Your doctor may also give you a prescription for folic acid (vitamin B9) or vitamin B12. These vitamins are also necessary to produce red blood cells.
Does chemotherapy-induced anemia go away after chemotherapy is done?
Chemotherapy-induced anemia often goes away once treatment ends and your body has time to repair itself. According to the Canadian Cancer Society, low blood cell counts typically begin to recover 2 to 4 weeks after chemotherapy ends.
In the meantime, you can do the following to manage your symptoms:
Getting plenty of rest and only doing activities you can handle
staying hydrated and drinking plenty of water
eating a balanced diet with lots of protein and iron-rich foods
Keeping a journal of your symptoms and noting when they occur
keeping your healthcare team updated about how you’re feeling
Planning activities for when you have the most energy
What are the potential complications of chemotherapy-induced anemia?
According to the American Cancer Society, anemia has been found to shorten the lifespan of people with cancer. It may delay cancer treatment, and sometimes the lack of oxygen to your cells can be life-threatening.
If your tissues aren’t getting enough oxygen, your heart has to work harder to move blood through your body. According to the National Heart, Lung, and Blood Institute, increased stress on your heart can worsen already present heart problems or lead to conditions such as:
arrhythmias
heart murmur
enlarged heart
heart failure
Breathing problems from anemia can make everyday tasks, like walking, difficult and impact your quality of life.
Takeaway
Anemia is a common side effect of chemotherapy. The chemicals in chemotherapy medications that destroy cancer cells can also damage healthy cells in your body. Anemia usually passes once chemotherapy stops.
Your cancer team can help you manage symptoms of anemia through medications, blood transfusions, and prescribing vitamins and minerals. It’s important to communicate with your team about any new symptoms you develop so you can build the best treatment plan possible.
Chemo diarrhea: Causes, prevention, and treatment
Diarrhea is a common side effect of chemotherapy. It can cause dehydration and malnourishment, making a person feel sick and potentially intensifying other chemo-related side effects.
A 2007 Current Oncology paper estimates that as many as 82% of people undergoing chemo experience diarrhea, with one-third developing severe diarrhea.
Why does chemo cause diarrhea?
Chemo helps kill cancer cells, but it can also target healthy cells. This damage to healthy cells can cause many of chemo’s side effects.
Researchers have proposed several reasons that chemo might cause diarrhea.
For example, certain chemo agents — especially those targeting colorectal cancer and other cancers of the digestive system — may damage the internal surface of the digestive tract, thereby leading to diarrhea.
A 2017 study in rats found that the drugs 5-fluorouracil, oxaliplatin, and irinotecan could damage the digestive tract, potentially explaining why people experience diarrhea when using these drugs.
Chemo may also upset the delicate balance of bacteria and other organisms that help a person digest their food and have normal bowel movements.
One 2019 meta-analysis of 13 randomized controlled trials found a reduction in diarrhea among people undergoing chemotherapy who took probiotics before or during treatment. This suggests that intestinal bacterial damage plays a role in chemo diarrhea.
Sometimes, cancer causes diarrhea by damaging the intestines or digestive system. Some cancer treatments, such as stem cell transplants, may cause graft-versus-host disease, which can cause diarrhea.
Anxiety and stress about cancer or cancer treatment may also contribute to this complaint.
Individual risk factors can also influence the likelihood of experiencing diarrhea during chemo. These factors include:
eating certain foods, such as sugary foods, high-fat foods, processed foods, or dairy products
using certain medications, such as laxatives, stool softeners, and some antibiotics
undergoing recent bowel surgery
Having underlying digestive or bowel disorders
having bacterial infections, which people are more vulnerable to when undergoing chemotherapy
Prevention
Some strategies that may help prevent chemo-induced diarrhea include:
Making dietary modifications: A person may wish to try lowering their intake of fat, sugar, and processed foods. Also, they should aim to choose bland foods — such as crackers, plain bread, boiled or steamed vegetables, and soft fruits — if they are not feeling well.
Taking probiotics: Taking probiotics may help reduce the risk of developing diarrhea. A person should talk with a doctor before using any new drug or supplement, including probiotics. Probiotics may also be helpful after recent antibiotic treatment for an infection.
Changing medication: People using stool softeners, laxatives, and other drugs that can induce diarrhea should talk with a doctor about stopping these drugs.
Drinking clear liquids: Drinking water and other clear fluids, such as electrolyte drinks, may prevent dehydration, which is a potentially serious complication.
Taking medications: Using certain medications can help reduce the risk of diarrhea, especially in people undergoing chemotherapy who have previously had severe diarrhea. Some doctors give an injection of the drug octreotide to prevent chemo-induced diarrhea.
Treatment
Diarrhea is usually a relatively minor chemo side effect, but some people experience severe diarrhea. In some cases, diarrhea can also be life-threatening. This is because severe dehydration can cause organ damage and even death.
A doctor will evaluate the diarrhea to determine whether or not it is severe and assess what might be causing it. The right treatment depends on the cause of diarrhea and the specific symptoms it causes.
Some treatment options include:
Diarrhea medications: Loperamide can help slow diarrhea and prevent dehydration. If this option does not work, a doctor might recommend additional medications, such as diphenoxylate or octreotide.
Dose changes: A doctor may recommend changing the dose of the chemo drug if a person has very severe diarrhea.
Antibiotics: Chemo weakens the immune system, increasing the risk of certain infections. When stool tests show evidence of bacteria causing diarrhea, a person may need antibiotics.
Probiotics: A doctor may recommend probiotics to help ease diarrhea symptoms. Some people find relief from eating probiotic-rich foods such as yogurt.
Intravenous fluids: If a person is very dehydrated, they may need intravenous fluids in a hospital.
Very severe diarrhea is diarrhea that:
leads to dehydration
involves incontinence
causes serious health problems
Very severe diarrhea may require a person to stay in the hospital for treatment and evaluation.
When to contact a doctor
Mild diarrhea may get better with home treatment, such as making dietary changes or using over-the-counter loperamide (Imodium).
However, it is important for people undergoing cancer treatment to discuss all symptoms and side effects with a doctor. People should tell their oncologist about their diarrhea at the next appointment.
A person should contact a doctor right away if they:
feel very sick or have any symptoms of dehydration, such as weakness, dry lips and skin, sunken eyes, or dark urine
have had three or more large stools per day for longer than a day, and noticed that this is not improving
have other symptoms, such as vomiting
have diarrhea that does not get better with medication
Notice blood in their stools
People should go to the emergency room if a doctor is not available or if it is after office hours.
Other chemo side effects
Chemo can cause a wide range of side effects. The specific effects may change with time, and different drugs are more likely to cause certain side effects. A doctor can help a person anticipate their most likely side effects.
Some common side effects of chemo include:
skin reactions at the injection site
mouth sores
nausea and vomiting
constipation
changes in mood or mental health, including depression and anxiety
brain fog or difficulty concentrating
more frequent infections and difficulty recovering from infections
Summary
Diarrhea is a common side effect of chemo, but it can also be serious.
There are many treatment options for dealing with chemo-related diarrhea. A person does not have to resign themselves to endless diarrhea, especially severe diarrhea.
A person should talk with a doctor about their symptoms and keep seeking help until the diarrhea gets better.
What Is Chemo Fever? Definition, Treatment, Prevention
"Chemo fever" is a term used to describe a fever caused by chemotherapy treatment, using powerful chemicals to kill fast-growing cells, like cancer cells, in your body. Fever is a possible side effect of both chemotherapy and biologic treatments.
Fever is normally the body’s response to infection. Experiencing a fever during chemotherapy requires immediate treatment. Chemotherapy causes a low white blood cell count in the blood. Without a normal level of white blood cells, the body cannot fight the infection. This could quickly lead to serious illness.
Definition
Chemo fever is a fever that occurs during or after receiving chemotherapy treatment. When you experience a fever during a round of chemotherapy, it is important to call your healthcare provider right away.
What Temperature Defines a Fever?
The average temperature of the human body is 98.6 degrees Fahrenheit. However, it is normal for body temperature to fall between 97 and 99 degrees, and even fluctuate depending on the time of day. Therefore, a fever is defined as a temperature at or above 100.4 in adults. In children, a fever is indicated by temperatures of 100.4 when measured rectally, 99.5 when measured by mouth, or 99 when measured in the armpit.
Chemotherapy lowers your body’s ability to fight infection by decreasing your white blood cell count. This is known as neutropenia. Fever is observed in up to 36% of individuals receiving chemotherapy.2
When Does Chemo Fever Commonly Occur?
A 2016 study found that individuals receiving chemotherapy are most likely to experience a fever during their first cycle of treatment. Fever may peak three to four days after treatment, and then again 10 to 14 days after treatment.
Diagnosis
If you are experiencing a fever during a round of chemotherapy, it’s important to let your medical team know right away so they can determine the cause of your fever. The doctor or nurse will start by asking questions about your symptoms and treatment plan. They will likely ask about your chemotherapy schedule and when your last dose was administered.
They will also ask if you are experiencing any other symptoms in addition to the fever. Symptoms to alert your medical team about include.
Skin sores
Redness, swelling, or pus around an IV (intravenous) site
New-onset pain
Cough
Mouth sores
A fever caused by chemotherapy usually does not cause other symptoms like redness, swelling, or pus. It’s possible to experience pain or achiness with a chemo fever.
Your healthcare provider may also recommend the following blood tests to evaluate your fever.
Complete blood count (CBC): A complete blood count will show your level of white blood cells and help the medical team determine your risk of infection.
Blood culture: A blood culture may be drawn to determine which type of virus or bacteria is causing the infection.
Febrile Neutropenia
If you are experiencing a fever when your white blood cell count is low, known as febrile neutropenia, you may be admitted to the hospital for close monitoring and intravenous antibiotics.
Treatment
A fever during chemotherapy treatment may be a medical emergency because an infection can quickly spread throughout the body and lead to sepsis, an extreme, life-threatening response to infection.3 As soon as you realize you have a fever, call your healthcare provider right away. Your medical team will work with you to determine the cause of your fever.
Over-the-Counter (OTC) and Home Remedies
Once your medical team has determined that your fever is being caused by chemotherapy and not an underlying infection, they may recommend over-the-counter medication, such as Tylenol (acetaminophen), to treat the fever and relieve any other symptoms. It’s important to talk with your healthcare provider before taking medication to treat a fever.
Chemotherapy often causes a low platelet count. Platelets are cells in the blood that clot the blood and prevent bleeding. If you have a low platelet count, your healthcare provider will advise you to avoid any nonsteroidal anti-inflammatory drugs (NSAIDs), like Advil or Motrin (ibuprofen), or aspirin, as these drugs can cause bleeding.3
Home remedies to help relieve fever symptoms include drinking fluids, resting, and using a cold compress on your forehead.
Make Sure OTC Medications Are Approved
To treat chemo fever, your medical team will recommend measures to address the symptoms. Talk with your healthcare provider before taking an over-the-counter medication.
Medications
If your healthcare provider discovers or suspects that your fever is due to an infection, they will start treatment right away. Treatment options include:3
Antibiotics: You will most likely receive a broad-spectrum antibiotic that is able to treat several types of infection. Once the medical team determines which virus or bacterium is causing the infection, you may receive a more specific antibiotic.
Colony-stimulating factors: Colony-stimulating factors, such as Neupogen (filgrastim), are drugs that work to boost the white blood cell count in the blood. These drugs can be given by IV or subcutaneous (SQ) injection and help the body to better fight the infection.
OTC medications: Your medical team may recommend taking Tylenol (acetaminophen) to relieve your symptoms.
Prevention
There is no way to always prevent chemo fever. The best option is to be prepared with a plan for when a fever occurs.
Talk with your healthcare provider about possible chemotherapy side effects and how to address them. Make sure that you have a working thermometer at home in a convenient spot. Know your healthcare provider's phone number or have it posted somewhere visible. Finally, if you have to go to the emergency room because of a fever, tell the health providers right away that you are receiving chemotherapy treatment.
When to Call a Healthcare Provider
During chemotherapy treatment, call your healthcare provider anytime you develop new symptoms, especially a fever. Anytime you feel warm, chilled, flushed, or just “off,” take your temperature. Any temperature above 100.4 degrees Fahrenheit or 38 degrees Celsius is considered a fever.5
Other symptoms often associated with fever include
Headache
Shaking chills
Body aches
Skin rash
Abdominal pain
Sore throat
Feeling confused or forgetful
If you have symptoms of a fever but your temperature is normal, plan to continue checking your temperature every two to three hours. Let your healthcare provider know what is going on, and keep monitoring yourself for fever.
Summary
Chemo fever is a possible side effect of chemotherapy. It’s also possible to experience an infection that leads to fever. Chemotherapy affects the body’s ability to fight infection, so it is important to call your healthcare provider as soon as you develop a fever. Your healthcare provider will likely perform lab tests to determine the cause of your fever and may admit you to the hospital for antibiotic treatment.
Infection and Neutropenia during Cancer Treatment
Infection is when harmful organisms, such as bacteria or viruses, enter the body, and the immune system cannot destroy them. The immune system is the body’s natural defence against infection and disease. The body’s other natural defence systems, such as the skin, also help protect you against infections.
Infections are common in people receiving cancer treatment because it lowers the number of white blood cells (WBCs). WBCs are an important part of the immune system and play a key role in defending the body against viruses and bacteria.
There is a greater risk of infection when WBCs, especially neutrophils, are lowered. Neutrophils are a type of WBC that surround and destroy bacteria. People receiving cancer treatment are most vulnerable to infection at a certain time in the treatment cycle when the number of neutrophils is very low. A low neutrophil count is called neutropenia. Not everyone receiving cancer treatment will have neutropenia, but many do. Neutropenia develops if too many neutrophils are destroyed before the bone marrow can replace them. Neutropenia usually occurs 10–14 days after receiving chemotherapy.
Once the WBC count drops, it remains low for a week or more. The low point in blood cell counts when the body’s resistance to infection is weakest is called the nadir. During nadir, it is important to do everything possible to lessen the chances of infection and to seek immediate treatment if an infection is suspected.
Infection can be very serious for people with cancer. Developing an infection can mean a hospital stay, delays in treatment, serious complications, and additional care. Pneumonia and chicken pox are 2 serious infections for people receiving cancer treatment. Infection is more common in children with cancer.
Causes
Infection can have many different causes, including the following.
Certain types of cancer
Some cancers, such as leukemia, multiple myeloma, and lymphoma, start in cells of the immune system. They can affect the bone marrow so it can’t make enough healthy WBCs. Cancer that spreads, or metastasizes, to the bone and bone marrow can lower the level of white blood cells, red blood cells, and platelets in the blood. Examples of cancers that spread to the bone and bone marrow include breast and prostate cancer.
Surgery and medical procedures
Surgery and other medical procedures break the skin or mucous membrane, which can allow organisms to enter the body. Indwelling central venous catheters are tubes placed in a vein in the neck, groin, or chest that remain in place for some time. They are used to give chemotherapy, blood products, intravenous fluids, and medicines. They can also provide a way for harmful organisms to get into the body. Urinary catheters or feeding tubes can also allow harmful organisms to enter the body.
Surgery to remove the spleen is called splenectomy. It is used to treat certain types of cancer. It may also lower resistance to infection because the spleen is an important part of the immune system.
Chemotherapy
Chemotherapy can cause bone marrow suppression. Bone marrow suppression is a condition in which the bone marrow doesn’t make enough healthy blood cells, including WBCs. Some chemotherapy drugs have a greater effect on the bone marrow and immune system than others.
Radiation therapy
Radiation therapy can affect the bone marrow and lower WBC counts. This is especially true if an area that contains a large amount of bone marrow, such as the pelvic bones, is treated with radiation. Treating a large part of the skeleton with radiation, such as total body irradiation, can also affect the bone marrow. Radiation therapy is also more likely to affect the bone marrow if you receive chemotherapy at the same time as radiation therapy.
Stem cell transplant
A stem cell transplant uses high-dose chemotherapy, radiation therapy, or both to kill cancer cells and destroy bone marrow cells to make room for new stem cells. A stem cell transplant lowers the WBC count for a while before new blood cells start to grow.
An allogeneic stem cell transplant uses stem cells from a donor. People who receive an allogeneic stem cell transplant can develop a condition called graft-versus-host disease (GVHD). They may be given drugs that suppress the immune system to prevent and treat GVHD. These drugs also increase the risk of developing infections.
Corticosteroids
Corticosteroids are drugs that act as anti-inflammatories by reducing swelling and lowering the body’s immune response. They may be used as part of cancer treatment or to help reduce pain and swelling associated with cancer. These drugs can suppress the immune system and may also hide the signs and symptoms of an infection.
General health
Cancer or its treatment can sometimes lead to poor nutrition. They can also cause a lack of sleep, stress, poor diet, and other side effects. These effects on your health may weaken the immune system and increase the risk of infection.
Diagnosis
Your doctor will try to find the cause of the infection. This may include asking about your medical history and doing a physical exam to look for any signs of infection.
You may also need to have the following tests:
blood tests, such as a complete blood count (CBC) or blood cultures
urinalysis or urine cultures to check for a urinary tract infection
cultures of mouth sores, skin or wound sores, intravenous sites, or vascular access devices to check if these are sources of infection
chest x-ray or a sample of sputum to check for pneumonia
stool samples, if you have diarrhea, to check for infection in the gastrointestinal tract
other imaging tests to check for pockets of infection or abscesses
A CBC checks the levels of the different types of blood cells. Higher numbers of white blood cells (WBCs) may indicate an infection. For people on chemotherapy, the WBC count may be low and may not show when an infection is present. Blood cultures may be done to check if an organism is causing an infection in the blood.
Cultures are done to identify the organism causing the infection. Samples from the site of infection are put on a special gel or in a broth to see which organisms grow. Sensitivity testing involves using samples of different antibiotics on the organisms to help identify which antibiotic would work best. Together, these tests are called culture and sensitivity (C&S).
Gram stain tests involve taking samples from the suspected site of infection. These samples are treated with certain stains or dyes that make the bacteria easier to see. Then they are looked at under a microscope. Gram stains can provide information about the type of organism. It may take 24–48 hours until test results are available.
Types of infection
An infection can be caused by many types of microorganisms, such as bacteria, viruses, fungi, or protozoa. Some of these microorganisms normally live on the skin, in the mouth, or in the intestines. These microorganisms do not usually cause a problem in people with a normal immune system. But when the immune system is not working as well because of cancer or its treatments, these microorganisms are allowed to multiply. These are called opportunistic infections, and they can be serious.
Bacterial infections
Bacteria are the most common type of infection-causing organism in people with cancer. Many bacteria live on and in our bodies. They are called normal flora. These bacteria do not usually cause infection. But they may cause problems, including serious infection, when the white blood cell counts are low and the immune system is weak.
Viral infections
Viruses cause infections, such as the common cold. Certain viruses can cause serious infections in people with very low WBC counts. Viruses are hard to identify and cannot be treated with antibiotics.
Fungal infections
Fungi can pose a problem for people with weakened immune systems. The most common fungal infection in people with cancer is thrush. Thrush is an infection of the mouth caused by the fungus Candida. Candida can also grow in a woman’s vagina and cause vaginal thrush, or a yeast infection.
Protozoan infections
Protozoa can cause serious infections in people with weakened immune systems due to an organ transplant, cancer, or other immune-suppressing illnesses. Toxoplasmosis is a serious protozoan infection that can damage the brain or heart.
Sites of infection
Infections can occur almost anywhere in the body. The most common places for an infection are the:
skin
mucous membranes
respiratory system, such as the sinuses or lungs
blood
urinary system, such as the bladder or kidneys
gastrointestinal (GI) tract, such as the mouth, stomach, or intestines
nervous system, such as the brain or spinal cord
Bacteria, viruses, or fungi can cause skin infections. They can also cause a serious infection of the respiratory tract called pneumonia.
Cancer treatments can cause changes in the mucous membranes of the GI tract that can lead to infections. They can also serve as an entry point for microorganisms living in the GI tract to invade the body. Mouth sores can become infected with yeast or the herpes simplex virus. People with cancer also have a higher risk of abdominal infections with bacteria, such as Clostridium difficile (C. difficile).
Symptoms
Symptoms of infection can vary. Having a fever, which is a temperature over 38 o C, is the most common sign of infection. But some people with an infection may not have a fever.
Other symptoms of infection include:
chills or shivering
unusual sweating
mouth sores or thick white patches inside the mouth
blisters on the lips or skin
redness, heat, swelling, or discomfort from a wound, surgical cut (incision), or area around an intravenous line or vascular access device site
sore throat
cough, which may produce phlegm
shortness of breath or rapid breathing
Frequent, painful urination
diarrhea
abdominal pain
vomiting
unusual vaginal discharge or itching
dizziness or light-headedness
increased sleepiness
irritability
weakness, including being too tired to eat, drink, or perform normal activities
sinus pain or pressure
earaches, headache, or stiff neck
Preventing infection
An antibiotic is a drug that fights bacterial infections. Antiviral drugs fight viruses, and antifungal drugs fight fungi. These drugs may be ordered if the white blood cell (WBC) count becomes too low and the healthcare team feels there is a high risk that an infection will develop. Giving drugs to prevent an infection is called prophylaxis. Antibiotics and other infection-fighting drugs may be given by mouth (orally) or intravenously.
In some cases, colony-stimulating factors (CSFs) may be ordered. These drugs stimulate the bone marrow to make more blood cells.
You can take the following steps to help lower your risk of getting an infection.
Practice good personal hygiene
This is one of the most effective ways of avoiding infection. Wash your hands frequently with soap and water. Carry a bottle of hand sanitizer in case a sink isn’t available to wash your hands. Always wash your hands when preparing food. Family members should always wash their hands when returning home from school, shopping, or work.
Have a shower, sponge bath, or bath every day to lower the amount of bacteria on the skin. Use an electric shaver instead of a razor when shaving to prevent breaks or cuts in the skin.
Keep a close watch on the mouth, anal area, biopsy and surgery sites, and areas of injury, such as cuts in the skin (especially on the fingers and toes), to monitor for any signs of infection. Clean the anal area gently but thoroughly after each bowel movement.
Avoid contact with stool and urine from pets and other animals. It is fine to play with a pet, but people with cancer should not groom the pet, empty litter boxes, or clean pet cages.
Protect your skin
Protect your skin from cuts and scrapes. Wash any cuts right away with soap and water and keep them clean. Apply a bandage to cuts and scrapes for the first few days to keep them clean.
Protect the hands and feet from cuts and injury. Wear gloves if working in the garden or with dirt, as garden soil and plants often contain bacteria. Always wear shoes or slippers to prevent cuts and bruises. Do not cut, bite, or tear the cuticles of the fingers or toenails. Use lotions and moisturizers on the skin to prevent drying, capping, and cracking.
Do not squeeze or scratch pimples. Use sunscreen, wear a hat or scarf, and find shady areas to avoid sunburn. Do not play or swim in ponds, lakes, or rivers.
Maintain good general health
Whenever possible, get enough rest, eat a well-balanced diet, drink plenty of fluids, and get regular exercise.
If you have low blood cell counts, take steps to protect yourself. Avoid anyone with signs or symptoms of an infection, such as fever, cough, sneezing, sore throat, or rash. Avoid large indoor crowds. If necessary, stay home from school or work. Do not schedule dental procedures or teeth cleaning. Let the healthcare team know if there has been contact with anyone suspected of having or diagnosed with chicken pox, measles, or mumps.
Practice food safety
Follow food safety guidelines to reduce the chance of contaminating food. Wash raw fruit and vegetables well before eating them. Do not eat raw or undercooked fish, seafood, meat, chicken, or eggs because they may contain bacteria that can cause infection. Do not have food or drinks that are mouldy, spoiled, or past the freshness date.
Do not share items such as spoons, forks, glasses, thermometers, or toothbrushes. Wipe the tops of cans and jars clean before opening them to reduce the chance of contamination from bacteria.
If tap water is a concern (for example, in homes that use well water), use bottled water while you are in treatment or consider purchasing a home faucet filter.
Practice good mouth care
Practice good mouth and dental hygiene 4 times a day. Use an extra-soft toothbrush that won’t hurt the gums. Replace toothbrushes every 3 months to reduce the chance of infection in the mouth. Get a new toothbrush after treating a mouth infection.
Check all surfaces of the mouth for sores each day. Your healthcare team may recommend using a mouthwash during chemotherapy to kill bacteria.
Plan dental checkups or dental procedures when blood cell counts are normal and there is less risk of infection. Visit the dentist regularly because care of the mouth and teeth is very important. Ask your dentist about using dental floss.
Use and care for medical devices properly
If you have a catheter, follow care instructions carefully and always wash your hands before handling the catheter.
Follow care instructions for venous access devices, such as a central venous catheter or peripherally inserted central catheter (PICC).
Avoid rectal thermometers, suppositories, and enemas. These can add to the risk of infection by introducing bacteria through tiny tears in the anus or rectum. Avoid constipation because straining can also cause small tears in the anus.
Ask about vaccines
Talk to your healthcare team about immunizations or vaccinations. Depending on the treatment given, there may be some vaccinations that should be avoided and others that should be given. In general, “killed” vaccines can safely be given. Examples of killed vaccines include those for the flu, pneumonia, hepatitis, and tetanus. Some “live” vaccines, such as those for the measles or mumps, may not be safe.
Managing infection
You can get sick very quickly if you have an infection when your white blood cells are low, even if you still feel well. Infection accompanied by fever and neutropenia is called neutropenic fever. It is a medical emergency in people with cancer, and it needs immediate attention and treatment. Infections can be life-threatening if they lead to a condition called septic shock.
If you are on chemotherapy, your healthcare team will usually advise you to go to your closest emergency department if you have a fever of 38 o C.
Using antibiotics to manage infection
If you develop an infection while your WBC count is low, your doctor will order tests. These tests may include blood cultures to try to identify the organism causing the infection. Your doctor will usually start you on a broad-spectrum antibiotic before the test results are known because infections can spread quickly. Broad-spectrum antibiotics are directed against many organisms that could be causing the infection. Once the cause of the infection is identified, the antibiotic may be changed to one that is specifically used to treat a particular organism.
Your doctor will select an antibiotic based on your history, symptoms, allergies, recent antibiotic use, and test results. For most infections, antibiotic treatment will continue for 7–14 days. Treatment depends on the organism causing the infection, your overall health, and how you respond to treatment. Different drugs are used to treat different types of organisms. These can be antibiotics, antivirals, antifungal, or other drugs.
If the infection does not respond to treatment after 3–5 days, the healthcare team may decide to add more drugs or change the drugs.
Doctors try not to overuse antibiotics because some bacteria can become resistant to them. When this happens, the bacteria will not be killed by the same antibiotic that worked before. This is called antibiotic resistance.
Managing a fever
A fever over 38 o C is the most common sign of an infection. A fever is the body’s way of protecting itself. When foreign substances, such as germs, enter the body, the body releases substances called cytokines to increase the temperature and make the immune system work better.
The surface air feels cooler as the body temperature increases, causing the body to shiver. Shivering occurs when the muscles contract to produce more heat. As the body temperature increases, it produces a fever. You can help lower a fever by taking acetaminophen (Tylenol) and helping the body get rid of heat. Preventing and correcting dehydration can also bring your fever down.
Acetaminophen will not treat what is causing the fever, but it will help lower the temperature and make you more comfortable. Do not take acetaminophen unless your doctor says it’s okay. Drugs can mask a fever, and it is important for the healthcare team to be aware of the fever and to treat the infection that is causing it.
Do not take acetylsalicylic acid (ASA, Aspirin, salicylate) or ibuprofen (Advil, Motrin) because these drugs promote bleeding, especially in the gastrointestinal tract. People receiving chemotherapy have a higher risk of bleeding. Take other medications prescribed for fever or infection only as ordered by your doctor.
To help keep cool, dress in light clothing that allows air to pass through to the skin and doesn’t trap body heat. Cover up with a light sheet and put a cool washcloth on the forehead for comfort. Drink cool fluids every hour to prevent dehydration. Change damp clothing and bed linens to prevent getting chilled.
Managing shaking chills
Shaking chills are also called rigors. They occur when the body shakes because it is cold. They are similar to shivering with an infection and fever, but are much more intense. You may get rigors from a very bad infection, from some drugs, or sometimes during a blood transfusion.
Let the healthcare team know right away if you have shaking chills. Try to relax, breathe deeply, and focus on the chills being gone. Keep warm with blankets, sweaters, and hot water bottles. When the rigors stop, you may feel very hot. Use cool washcloths on your head and neck for comfort.