Sepsis During Cancer Treatment

NCI's instruction is short. Call your health care team if you have signs of an infection. Infections during cancer treatment can be life threatening and require urgent medical attention.

This is the list NCI gives:

• A fever of 100.4 °F (38 °C) or higher.
• Chills.
• Cough or sore throat.
• Diarrhea.
• Ear pain, headache or sinus pain, or a stiff or sore neck.
• Skin rash.
• Sores or white coating in the mouth or on the tongue.
• Swelling or redness, especially where a catheter enters the body.
• Urine that is bloody or cloudy, or pain when urinating.

Every one of those is a phone call to oncology, made when you notice it. Not a portal message, and not a wait until morning.

That holds while the person is otherwise stable. If any of the signs in the emergency list further down are there too — fast breathing, confusion, mottled or blue-tinged skin, a weak fast pulse, severe pain, or someone who simply looks to be going downhill — that is 911, not a phone call to the clinic.

No clinician has reviewed this page yet. Use your own team's instructions where they differ.

NCI prints 100.5 °F (38 °C). MedlinePlus prints 100.4 °F (38 °C) for the same thing.

We print each figure as its source publishes it, and we are not going to explain the tenth of a degree away. 38.0 °C converts to 100.4 °F; why NCI settled on 100.5 is not something the agency states. Sources word this threshold differently, which is why you may have seen both. Your own hospital may use another number again, and that is the one that governs your care.

If your own team gave you a number, use theirs. If you land between the two and are not sure, call. No oncology service minds being called about a fever.

Some signs are past a call to the clinic. Call 911. CDC lists these as the signs of sepsis:

• Confusion or disorientation.
• Shortness of breath.
• A high heart rate or a weak pulse.
• Fever, shivering, or feeling very cold.
• Extreme pain or discomfort.
• Clammy or sweaty skin.

The UK's NHS list, written for an adult or a child aged 5 or over, covers much the same ground and names two more worth recognising: skin that has gone blue, pale or blotchy, which on black or brown skin shows sooner on the palms and soles, and a rash that does not fade when you press a glass to it. NHS also says to act on any symptoms you are worried might be sepsis, which is good advice anywhere.

NHS says sepsis usually develops quickly over a few hours, and that untreated it can turn into septic shock, which people die from. CDC puts it as: without fast treatment, sepsis can quickly lead to tissue damage, organ failure and death.

One practical instruction, from NHS: do not drive yourself. Ask someone else to drive, or call 911 for an ambulance. Bring your medicines with you, and say at the door that you are having cancer treatment.

The temptation is to take something, watch for an hour, and call only if it does not settle.

NCI's wording rules that out. Talk with your doctor or nurse before taking medicine for a fever, even aspirin, acetaminophen or ibuprofen. Its reason is not that the medicines are dangerous. It is that they can lower a fever but may also mask or hide signs of a more serious problem.

Making the call first does not stop you taking anything afterwards. It just stops the one thing that hides the picture.

Triage sorts people by how sick they look. Someone with low counts can look well and be in serious trouble, so the history has to do the work.

NHS names two things that raise the chance of sepsis and that apply to a lot of people in treatment: having a weakened immune system because you are having chemotherapy or taking corticosteroids or immunosuppressants, and having a urinary catheter. NCI separately lists swelling or redness where a catheter enters the body as a sign of infection to report.

So say both out loud:

• "I am having chemotherapy." Name the drug and the date of the last dose if you can.
• "I have a port" or "I have a central line" or "I have a urinary catheter."
• The temperature, and the time you took it.
• Anything from NCI's infection list above.

Carrying a card or a phone note with the diagnosis, the regimen, the last treatment date and the oncology after-hours number makes this survivable when you feel awful.

NCI explains why this is a treatment problem rather than a general one. Some cancers and treatments such as chemotherapy lower the number of white blood cells, the cells that fight infection.

More usefully, it says the risk is not flat. During chemotherapy there will be times in the cycle when the number of neutrophils is particularly low, and the risk of infection is higher then. Blood tests are used to check for neutropenia.

That is worth asking about by name, because it turns a vague worry into specific days.

NHS says sepsis is treated in hospital, and lists the core of it: antibiotics, usually a general one to start with and a more specific one once the cause of the infection is confirmed; oxygen to help with breathing; and fluids given into a vein.

Some people need a specialist care unit so they can be watched closely. Knowing that in advance takes some of the fright out of the words "we are admitting you."

Creating a Cancer Symptom and Call Plan, What to Have Ready for an Urgent Oncology Call, Preparing for an Emergency Department Visit With Cancer, and What Counts as a Fever During Chemotherapy?.

• National Cancer Institute — Infection and Neutropenia during Cancer Treatment
• NHS — Sepsis
• MedlinePlus — Cancer treatment: preventing infection
• CDC — About Sepsis