When this happens, you are often advised to see your doctor right away or go to the emergency center. Your doctor will perform a careful evaluation to look for a source of the fever and prescribe antibiotics. Antibiotics are still prescribed in this situation, and often the fever resolves as the neutrophils increase. What are the signs of infection caused by neutropenia? Typical signs of infection include:. What should I do if I think I have an infection?
Contact your doctor or a member of your care team. You may be asked to go to the emergency center for immediate treatment. What can I do to prevent infection?
I encourage patients to follow these common practices to protect against illness and infection:. You can download this educational document for additional prevention measures. What can happen as a result of neutropenia? If you are neutropenic, your doctor may temporarily halt your cancer treatment to give your body time to increase its white blood cell levels.
How do doctors manage neutropenia? It can lead to febrile neutropenia FN , and it is associated with increased morbidity and early mortality, increased medical costs, and disruptions in potentially curative treatments.
The incidences of CIN and its complications, such as fever, infection, and chemotherapy dose alterations, vary by type of malignancy. Hospitalization and treatment with empiric broad-spectrum antibiotics is typically required in patients with FN, and it has been estimated that in the United States more than 60, patients a year are hospitalized for FN. These hospitalizations account for substantial mortality and medical costs.
A review of discharge data from the University HealthSystem Consortium UHC , which comprises institutions, examined inpatient mortality in 41, nontransplant patients who had been hospitalized for FN in through and found that it was higher in patients with leukemia than in those with lymphoma and solid tumors Figure 1.
A minority of patients in the UHC database accounted for a disproportionate amount of medical costs. It should be noted that the medical costs in the UHC discharge records are only the direct costs of hospitalization and that other costs incurred by patients can substantially increase the total costs of an occurrence of FN.
A survey of 26 patients with ovarian cancer in whom World Health Organization grade 3 or 4 CIN had occurred captured both its direct and its indirect costs in the 3 months after its occurrence.
The indirect costs included patient work loss, family member work loss, and caregiver payments. There is increasing evidence that neutropenia is also associated with important-although more difficult to measure-effects on patient quality of life QOL.
Hospitalization for FN and the fear of hospitalization have obvious negative effects on patient QOL,[6] but the effects of neutropenia are more subtle. Lower absolute neutrophil counts were found to correlate with lower ability for physical work, worse physical symptoms, and greater psychological distress.
The most insidious effect of CIN may, however, be the disruption of the cancer treatment-with potentially serious consequences for long-term survival. Dose reductions and delays are common in patients treated with chemotherapy. Most clinicians would name CIN and its complications as the most frequent causes of chemotherapy dose delays and dose reductions, and recent data support this.
A retrospective analysis of practice patterns examined regimen alterations in 1, patients who were treated with adjuvant therapy with cyclophosphamide, methotrexate, and fluorouracil CMF , doxorubicin and cyclophosphamide AC , or other regimens for early-stage breast cancer. Such alterations in chemotherapy regimens may help ameliorate the immediate problem of neutropenia, but their long-term effects are clearly negative.
The most recent update of the classic study by Bonadonna and colleagues well illustrates this point. At a median follow-up of When you put all that together, there are many patients who are at high risk of FN, even with the intermediate range myelosuppressive regimens. The frequency of CIN depends on the myelosuppressive intensity of the chemotherapy.
Combination chemotherapy with drugs that are highly myelosuppressive like taxanes or combinations of platins, like carboplatin, and a taxane tend to be higher. Regimens with anthracyclines tend to be higher. If you develop a fever, let your doctor know right away. Keep track of your blood counts. During cancer treatment, your health care team will monitor your blood cell counts. You may want to keep track of this information as well. Record your blood counts in a log so you know when your neutrophil count is low and you need to take extra precautions.
If your white blood cell count becomes very low, your doctor may prescribe growth factors to raise your counts before you resume chemotherapy. Wash your hands often. Hand washing is an important way to prevent infection. Wash your hands after using the bathroom, shaking hands, coughing or sneezing. Encourage the other members of your household to do the same. Avoid contact with sick people.
Until your counts have fully recovered, you may help prevent infection by avoiding large crowds of people, such as in shopping malls or other enclosed public areas. Avoid contact with people who are sick with colds, viruses or other infections, or who have recently received virus-based vaccines. Also, do not share food, drinking glasses, utensils or personal hygiene products.
Practice good oral hygiene. Good dental hygiene during and after cancer treatment, including proper cleaning of the mouth and teeth, may help reduce complications, such as mouth sores and infections. Use a soft-bristled toothbrush to prevent cuts, and rinse your mouth often with sterile water or a bland, non-irritating solution.
Your dentist may offer guidance on how to safely keep your mouth clean when your blood counts are low.
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