Fever
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This patient summary on fever, sweats, and hot flashes
is adapted from a summary written for health professionals by cancer experts.
This and other credible information about cancer treatment, screening, prevention,
supportive care, and ongoing clinical trials, is available from the National
Cancer Institute. Fever is a rise in body temperature above the normal temperature.
In a person who has cancer, fever may be caused by infection, a tumor, drug
reactions, or blood transfusion reactions. Sweating is the body's way of decreasing
body temperature by causing heat loss through the skin and, in a person who
has cancer, may be associated with fever, a tumor, or cancer treatment. Hot
flashes can also cause excessive sweating and may occur in natural menopause
or in patients who have been treated for breast cancer or prostate cancer.
This brief summary describes the causes and treatment for fever, sweats, and hot flashes.
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Normal human body temperature changes during each
24-hour period according to a definite pattern. It is lowest in the morning
before dawn and highest in the afternoon. Normal body temperature is maintained
by temperature control activities in the body that keep a balance between heat
loss and heat production.
An abnormal increase in body temperature is caused
by either hyperthermia (an unusual increase in body temperature above normal)
or fever. Hyperthermia is caused by a breakdown in the body's temperature control
activities. In fever, the temperature controls in the body are working correctly,
but body temperature increases as the body responds to chemicals produced by
microorganisms that cause infection or works to kill harmful microorganisms
such as bacteria or viruses. There are three phases to fever. In the first
phase, the body raises its temperature to a new level by causing the blood
vessels in the skin to constrict and move blood from the skin surface to the
interior of the body which helps to retain heat. The skin becomes cool, the
muscles contract causing shivering or chills, and the body produces more heat.
The body's efforts to retain and produce heat continue until a new higher temperature
is reached. In the second phase, heat production and heat loss are equal, shivering
stops, and the body maintains the new higher temperature. In the third phase, body
temperature is lowered to normal as the body gets rid of the excess heat by
causing the blood vessels in the skin to open and move blood from the interior
of the body to the skin surface. Sweating occurs and helps to cool the body.
Fever is most likely to cause harmful effects in older
persons or the very young. In older persons, the hypothalamus' temperature
regulating centers do not work as well and the body temperature may rise above
normal causing irregular heartbeat, lack of blood flow, changes in the ability
to think clearly, or heart failure. Children between 6 months and 6 years old
may have seizures due to a fever.
The main causes of fever in cancer patients are infections,
tumors, reactions to drugs or blood transfusions, and graft-versus-host-disease.
Graft-versus-host-disease occurs when transplanted bone marrow or peripheral
stem cells attack the patient's tissue. Infection is a common cause of fever
in cancer patients and can cause death. Tumor cells can produce various substances
that can cause fever. A wide variety of medications can cause fever including
chemotherapy drugs, biological response modifiers, and antibiotics, such as
vancomycin and amphotericin.
Other causes of fever in cancer patients include
drug withdrawal; neuroleptic malignant syndrome; blockages of the bladder,
bowel, or kidney; and blockage of an artery by tumor fragments. Other medical
conditions occurring at the same time as the cancer such as blood clots, connective
tissue disorders, and central nervous system hemorrhage or stroke, may also
cause fever.
The doctor will ask questions about past medical
problems, review all medications the patient is taking, and perform a thorough
physical examination to determine the cause of fever. Patients who are suspected
of having an infection, especially those who have neutropenia (a very low white
blood cell count) and fever, will undergo very careful inspection of the skin,
body openings (mouth, ears, nose throat, urethra, vagina, rectum), needle stick
sites, biopsy sites, and skin folds (for example, the breasts, armpits, or
groin). The teeth, gums, tongue, nose, throat, and sinuses will be carefully
examined. Any tubes that are inserted into veins or arteries or other tubes
placed in the body, such as stomach tubes, are common sources of infection.
Urine, sputum, and blood specimens will be examined for signs of infection.
Patients with neutropenia may not show the usual symptoms of infection, so
they should be examined frequently.
The symptoms of fever in very weakened cancer patients
may include fatigue, muscle pain, sweating, and chills. Possible treatments
to manage fever include those that treat the underlying cause, giving intravenous
fluids, nutritional support, and other measures to make the patient more comfortable.
The specific treatments are determined by the stage of cancer and the patient's
goals for care. For example, some patients who are nearing the end of life
may decide not to be treated for the underlying cause such as pneumonia or
other infections, but may still request general comfort measures and fluids
to maintain their quality of life. Other patients may choose antibiotics to
relieve symptoms such as cough, fever, or shortness of breath that occur because
of the infection.
Antibiotics may be used to treat fever caused by
infection. Antibiotic therapy regimens and drugs to treat fungal infections
are prescribed by the doctor. Fever caused by a tumor is usually treated by
prescribing standard therapies for the specific type of cancer. If the therapy
is not successful, the therapy takes awhile to work, or there is no therapy
available, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs).
Sometimes fever may be caused by a reaction to drugs
given to treat the cancer or prevent infection. Drugs that are known to cause
fever include biological response modifiers, amphotericin B, and bleomycin.
Suspected drug-related fever may be treated by stopping the drug that is causing
the fever. When a biological response modifier, certain chemotherapy drugs,
or antibiotics cause the fever, the doctor may control the fever by adjusting
the type of drug, how the drug is given, the amount of drug given, or how often
the drug is given. Acetaminophen, NSAIDs, and steroids may also be given before
the patient receives the drug that causes the fever. Meperidine may be given
to stop chills associated with a drug-related fever.
Neuroleptic malignant syndrome (NMS) is a rare but
sometimes fatal reaction to drugs that a patient is given for psychotic conditions,
delirium, or nausea and vomiting. The symptoms of NMS are fever, muscle stiffness,
confusion, loss of control of body functions, and an increase in white blood
cell count. A delirious patient who does not improve when treated with medication
should be examined for NMS. Treatment for NMS includes stopping the drug, treating
the symptoms, and sometimes using other drugs.
Cancer patients may develop a fever as a reaction
to blood products (for example, receiving a blood transfusion). Removing white
blood cells from the blood or treating the blood product with radiation before
transfusing it into the patient can lessen the reaction. The possibility of
fever due to receiving blood products can also be lessened by giving patients
acetaminophen or antihistamine before the transfusion.
Along with treatment of the underlying cause of
fever, comfort measures may also be helpful in relieving the discomfort that
goes along with fever, chills, and sweats. During periods of fever, giving
the patient plenty of liquids, removing excess clothing and linens, and bathing
or sponging the patient with lukewarm water may give relief. During periods
of chills, replace wet blankets with warm, dry blankets, keep the patient away
from drafts, and adjust the room temperature to improve patient comfort.
Nonsteroidal anti-inflammatory drugs (NSAIDs) or
acetaminophen may also be prescribed to relieve symptoms. Aspirin may be effective
in decreasing fever, but should be used with caution in patients with Hodgkin's
lymphoma and cancer patients who are at risk for developing a decrease in the
number of platelets in the blood. Aspirin is not recommended in children with
fever because of the risk of developing Reye's syndrome.
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Sweat is made by sweat glands in the skin. Sweating
helps to keep the body cool and can occur with disease or fever, when in a
warm environment, exercising, or as part of hot flashes experienced with menopause.
Most breast cancer and prostate cancer patients report having moderate-to-severe
hot flashes. Distressing hot flashes seem to be less frequent and gradually
decrease with time in most postmenopausal women who do not have breast cancer.
In breast cancer survivors, however, hot flash intensity does not decrease
with time. Most men with prostate cancer who have had surgery to remove the
testicles experience hot flashes.
Sweats in the cancer patient may be associated with
the tumor, cancer treatment, or other medical conditions that are not related
to the cancer. Sweats are a typical symptom of certain types of tumors such
as Hodgkin's lymphoma, pheochromocytoma, or tumors involving the nervous system
and endocrine system. Sweats may also be caused by:
- Fever.
- Female menopause (natural menopause, surgical removal of the ovaries, or damage
to ovaries from chemotherapy, radiation, or hormone therapy).
- Male menopause (surgical removal of the testicles or hormone therapy).
- Drugs such as tamoxifen, opioids, antidepressants, and steroids.
- Problems in the hypothalamus in the brain.
- Sweating disorders.
Treatment of sweats caused by fever is directed
at the underlying cause of the fever. Sweats caused by a tumor are usually
controlled by treatment of the tumor.
Hot flashes associated with natural or treatment-related
menopause can be effectively controlled with estrogen replacement. Many women
are not able to take estrogen replacement (for example, women with breast cancer).
Hormone replacement therapy that combines estrogen with progestin may increase
the risk of breast cancer or breast cancer recurrence. A variety of other medications
to treat hot flashes have varying degrees of effectiveness or have unacceptable
side effects. The most effective drugs include megestrol (a drug similar to
progesterone) and certain antidepressants such as venlafaxine. Many other drugs
as well as vitamin E and soy are less effective in relieving hot flashes. Relaxation
training may be effective in decreasing hot flash intensity in postmenopausal
women who are in general good health.
A variety of other medications are being used for
general treatment of cancer-related sweats. The use of loose-fitting cotton
clothing, fans, and behavioral techniques such as relaxation training is also
recommended.
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