Managing Risks of Infection and Fatigue from Drug Therapy

Lower blood counts

Cancer drug therapy (chemotherapy) can lower the count of your red and white blood cells. This can cause problems that include:

  • Anemia: A shortage of red blood cells or hemoglobin can cause anemia. This can prevent your blood from carrying enough oxygen to your body.
    If the anemia becomes severe, you may need a blood transfusion. Symptoms of anemia can include feeling tired (fatigue), short of breath, dizziness, getting pale skin and feeling colder than normal.
  • Low count of white blood cells: If you don’t have enough white blood cells, your body is less able to fight off infections. If you get an infection, you may need antibiotics or need to stay in the hospital. Many cancer drugs lower your blood cell counts. It is important for you to report a fever that lasts at least 1 hour that is more than 100.4°F (38°C) without the use of acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), as these medicines may mask a fever.
    Your team may check the count of one kind of white blood cell (your absolute neutrophil count, or ANC). If that is too low, you may be having a medical emergency that requires a hospital stay.
  • Low counts of platelets: Report any bruising or bleeding that does not stop within 10 minutes when pressure is applied on the site of the bleeding.

Low count of white blood cells

Your white blood cells fight infection. They are a key part of your immune system. Your risk for infection may rise from the type of treatment you get. In general, the more chemotherapy you get, the more risk there is that the count of your white blood cells will be low.

White cells usually go down to their lowest level about 7 to 10 days after chemotherapy. Then they start to recover. This low point is called the nadir. Good nutrition can help your body as it recovers on its own.

Fevers and infection

Please make sure that you have a good thermometer at home. Fever is often the only sign of infection. Call us at 650-498-6000 if you have a temperature higher than 100.4°F (38°C) sustained for over 1 hour without the use of acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

If you ever have a fever at home greater than 101°F, you need to call our office day or night at 650-498-6000.

Fevers can be a sign of infection. If your white cell count is low, it is hard for your body to fight infection. With fevers, we will likely ask you to come in so we can check your blood counts or evaluate you for infection.

If your blood counts are getting too low before each treatment, we may use a medicine to help. The medicine can help boost your bone marrow to make more white blood cells. Sometimes it may be necessary to delay your treatment.

Medicines used to help this include:

  • Filgrastim (Neupogen) injection
    This medicine is given by injection daily for 3 to 7 days. The nurses will teach you or a family member how to do the injections under the skin at home.
    This medicine is used to help prevent your white blood cell count from getting too low. It also helps to prevent fever and infections linked to low white blood cell counts. This is used only when we are concerned about low white blood cell counts. It is not used with every chemotherapy drug plan.

    This medicine can cause body aches and bone pain (in the back, chest, or long bones). You may use acetaminophen (Tylenol) or ibuprofen (Motrin) if you need it.

There are alternative forms of filgrastim (Neupogen) that your doctor may recommend. They include:

  • Pegfilgrastim (Neulasta) injection is given one time on the day of or the day after chemotherapy. This is a long-acting form of Neupogen. It is given only once after chemotherapy. 
  • Neulasta Onpro is a patch that your insurance company may have you use for self-injected administration.

Feeling tired

This common side effect of cancer treatment can increase as you continue therapy. The tiredness can continue even after your treatment is complete.

If your tired feeling becomes severe, we can prescribe medicine. We can also adjust your drug treatment dose or schedule, if needed.

While you are getting drug therapy, these tips can help:

  • Get regular exercise, like walking 30 minutes twice a day, and rest. 
  • Follow good sleep habits.
  • Get good nutrition.
  • Ask your care team for more information on support services and things you can do to feel less tired.

 

Current as of: 6/2019

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