Using buses and trains during chemotherapy

This page is for people having chemotherapy who need to use buses or trains. It explains what the infection advice actually asks of you, and how to cut down your time in crowds.

• Call 911 or go to the nearest emergency department if you collapse, are hard to wake, or cannot get enough air.
• Call your care team right away, day or night, for a temperature of 100.4°F (38°C) or higher. CDC says to call your doctor right away at that temperature.
• Also call right away, day or night, for chills, sweats, a new cough, a sore throat, mouth sores, urination problems, or redness or swelling at a wound or port. CDC lists these as signs of infection during chemotherapy. You do not need a fever. A normal temperature is not a reason to wait.

NCI states that infections during cancer treatment can be life threatening and require urgent medical attention. Its instruction is short. Call your health care team if you have signs of an infection. Do this even if you feel otherwise well.

NCI's advice for avoiding germs during cancer treatment includes these lines: "Stay away from people who are sick or have a cold." and "Avoid crowds and people who have just had a live vaccine, such as one for chicken pox, polio, or measles."

MedlinePlus, writing for people whose immunity is weakened, says much the same. It says to stay away from crowds. It says to ask visitors who have a cold to wear a mask or not to visit. It also says to consider wearing a face mask when outside of your house.

Neither source mentions buses, trains, or transport of any kind. They name crowding and closeness to people who are unwell. A commute is only a problem to the extent that it delivers those two things.

A rush-hour carriage where you are pressed against strangers is a crowd. The same line at eleven in the morning, half empty, is not.

Most of the useful adjustments follow from that:

• Travel outside peak hours whenever your schedule allows.
• Walk down the platform to a quieter carriage rather than boarding the nearest door.
• Wait for the next service if one arrives full — the cost is a few minutes.
• Choose a seat with space around it over a seat in the middle of a full row.
• Book appointments at times that let you avoid the worst of the crush.

Avoiding crowds is a scheduling problem more than a transport problem.

NCI puts hand hygiene first in its infection guidance: "Wash your hands often and well. Use soap and warm water to wash your hands well, especially before eating."

On public transport you touch handrails, poles, ticket barriers, door buttons and seat backs. Many other people touch them too. Those surfaces only matter because hands eventually go to faces and food.

So the habit that pays off most is simple: hands washed when you arrive, and definitely before you eat anything. If you are heading somewhere without a sink, carry something that lets you clean your hands on arrival.

You cannot control who sits near you. You can move, and moving is a reasonable thing to do. If somebody nearby is coughing steadily, change seats or change carriage. Nobody will notice, and NCI's advice to stay away from people who are sick is exactly this situation.

MedlinePlus says people with weakened immunity can consider wearing a face mask when outside of the house. A bus or train is outside the house. Ask your team whether they want you masked while travelling. The answer may depend on how low your counts are at that point in your treatment.

Chemotherapy does not suppress counts evenly across a cycle. CDC says white blood cell counts often drop between 7 and 12 days after you finish each chemotherapy dose. That is the period when crowd advice matters most.

Ask your team which days those are for your regimen. Knowing that you need to be careful for a specific handful of days each cycle is far more workable than trying to be careful all the time. It also means the rest of the cycle can look more like normal life.

Some people end up avoiding appointments because the journey is hard, not because they do not want to attend. If that is you, say it out loud at the clinic. The American Cancer Society's Road To Recovery program offers free rides to cancer-related appointments. Call 1-800-227-2345 well ahead, since a ride can take several business days to arrange.

• National Cancer Institute — Infection and Neutropenia during Cancer Treatment
• CDC — Signs and Symptoms of Infection During Chemotherapy
• CDC — Watch Out for Fever
• MedlinePlus — Pneumonia, weakened immune system
• American Cancer Society — Road To Recovery