A fever is defined as a temperature rise above normal, ranging from a temperature equal to or greater than 100.4º F, or as set by your doctor’s office. Fever is a very important warning sign of infection in patients with cancer. Fever is generally lowest in the very early morning and highest in the afternoon.

How do people describe fever?

Depending on how long a fever is present, it can become an emergency. Most people have a normal body temperature range of 98.0º F to 98.6º F by mouth, but can go from 97º F to 99.6º F (one degree higher rectally). Patients with low white blood cell count may develop an infection with fever. In fever, body temperature increases as the body responds to chemicals produced by microorganisms or works to kill harmful microorganisms. Shivering and chills may occur. In the late phase of the body response, sweating may occur. Fatigue and muscle pain may also occur.

What causes fever?

Bacteria can enter the blood stream through any entrance, such as the skin, mucous membranes that line the mouth and gastrointestinal tract. The immune system attacks bacteria in the blood and releases substances causing the brain to raise the body temperature. It is estimated that over 30% of people with cancer are at risk for developing neutropenia (low white blood count) and will develop a fever sometime during the course of cancer treatment. Common locations for infection include lungs, vaginal urinary system and skin. Fever can be due to infection or tumor. Causes include drugs, reaction, cancer treatment, blood transfusion reactions and autoimmune problems. Most biotherapy drugs such as interleukin-1, interferons can also cause fever.

How do people cope with fever?

Here are some suggestions to cope with fever:

• Because fever increases metabolism, eat foods that contain proteins and calories, such as peanut butter, vitamin D milk products, carnation instant breakfast.
• Have an easy-to-read thermometer on hand.
• Drink 8 glasses (8 oz.) of fluid to keep hydrated. Fluids can include water, lemonade, lemon-lime soda, popsicles, broth or other soups.
• Try to avoid caffeine, such as coffee, dark cola drinks and Mountain Dew, as caffeine makes one more dehydrated.
• A luke-warm sponge bath or shower can help relieve the discomfort of fever and chills.
• Wash hands with antibacterial soap often and with extra care, but especially after using the bathroom, blowing the nose, or handling raw meat, fruits or vegetables.
• Take temperature daily, or as recommended by your doctor or nurse.
• If a fever is present, take your temperature at least every 4 hours for 24 hours.
• Avoid contact with crowds or large groups of people.
• Avoid people who are known to be sick.
• Air conditioning or a fan can also make one feel more comfortable.
• Adjust the room temperature for your comfort.
• Try an ice pack wrapped in a towel or washcloth to the body, such as the forehead or under the arms.
• Try to avoid any nicks or cuts by wearing gloves if gardening or washing dishes.
• Call the doctor or nurse with any new fever of 100.4º F or above for over 24 hours. Write down how long the fever has been present, along with any accompanying symptoms such as chills, shakes, nausea, vomiting, pain when urinating, any reddened or warm area or draining sores, and report these.
• If one has chills, try a warm, moist pack or warm water bottle.
• Avoid taking any Tylenol or aspirin products before talking with the doctor or nurse.

• Ask family members and friends to prepare high protein and calorie foods.
• Have family members and friends encourage one to drink fluids throughout the day.
• Have family members and friends call the doctor’s office when warranted. (See below)
• Ask the family members and friends to draw a luke-warm shower or bath.
• Ask family and friends to help one stay free from an infection by washing their hands, and by asking others who visit to wash their hands.

• Tell family members and friends how the fever makes one feel.
• Ask family members and friends for suggestions to help relieve fever.

• Spike of fever greater than 100.4º F. Make sure when temperature is taken (about every 4 hours) that the patient hasn’t had any hot drinks in the last 10-15 minutes.
• Any fever that is also accompanied by:
  • Pain on urination, frequency,
  • Shortness of breath,
  • Cough with yellow or green phlegm,
  • A draining sore or wound,
  • Severe fatigue, unable to get out of bed,
  • Chills and body aches,
  • Vaginal discharge,
  • Confusion.

• Call your doctor or nurse.
• Call your American Cancer Society at: 1-800-ACS-2345, or visit on the internet at: http://www.cancer.org. Click on Patients, Family & Friends, then Coping with Treatment.
• Call the National Cancer Institute at 1-800-4-CANCER, or visit on the internet at: http://www.cancer.gov/cancerinfo/. Click on Coping with Cancer (Fever, Sweats and Hot Flashes).
• Call the Oncology Nursing Society at: 1-866-257-4ONS or visit on the internet at: http://www.cancersourcern.com. Click on Patient Information.
• Visit the University of Pennsylvania Oncolink on the internet at: http://www.oncolink.upenn.edu. Click on Coping with Cancer.
• Visit the Family Care Research Program on the internet at: http://www.cancercare.msu.edu.

• Arnold, S.M., Patchell, R., Lowly, A.M., & Foon, K.A. (2001). Paraneoplastic Syndromes, cpt 47 in VT DeVita, S Hellma, SA Rosenberg (Eds) Cancer Principles and Practice of Oncology, 6th Ed Philadelphia, PA: Lippincott, Williams and Wilkins.
• Ezzone, S.A. (2000). Fever. In D Camp-Sorrell and RA Hawkins (Eds.), Clinical Manual for the Oncology Advanced Practice Nurse, Chapter 140. Pittsburgh, PA: Oncology Nursing Press, Inc.
• Shelton, B. (2003). Flulike Syndrome. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer symptom management, 3rd Ed. (pp. 61-76). Boston: Jones and Bartlett.