chemo side effects with fever

Overview

Fever during chemotherapy is a rise in body temperature that can be a sign of infection. Chemotherapy can lower your white blood cells, which are part of your immune system. When these cells are low, your body may struggle to fight germs, so a fever is treated as a medical emergency.

Fevers are fairly common during chemotherapy, especially in the first few weeks after treatment when white blood cell counts are lowest.

Anyone having chemotherapy can develop a fever, but it is more likely in people with low white blood cell counts, those with certain blood cancers, and those receiving intensive treatment.

Symptoms

Common symptoms

• A temperature of 100.4°F (38°C) or higher
• Chills or shivering
• Sweating
• Feeling generally unwell or very tired
• Sometimes no other symptoms, but you may also have a sore throat, cough, or pain when urinating

Symptoms in children

• A fever is the same — 100.4°F (38°C) or higher
• Child may seem unusually sleepy, fussy, or want to be held
• Poor feeding or vomiting
• Breathing faster than usual

Symptoms in older adults

• May not get a high fever — even a small temperature rise can be serious
• Confusion or feeling more tired than usual
• Falls or changes in balance
• Not feeling like eating or drinking

Causes

Main causes

• Chemotherapy lowers white blood cells, a condition called neutropenia, making you less able to fight infection
• Infections from bacteria, viruses, or fungi are the most common cause of fever during chemo
• Sometimes a drug reaction or other treatment side effect can cause fever

Risk factors

• Low white blood cell count (neutropenia) after chemo
• Receiving intensive or high-dose chemotherapy
• Age under 18 or over 65
• Having certain cancers, such as leukemia or lymphoma
• Having a central line or catheter in a vein
• Contact with someone who is sick or being in crowded places

When to see a doctor

See a doctor urgently if:

• Call your oncology team immediately if you have a fever of 100.4°F (38°C) or higher
• Call if you have chills, sweats, or any symptom of infection
• Seek emergency care if you have breathing trouble, confusion, or fainting

Book a routine appointment if:

• If you have a scheduled appointment and notice any unusual symptoms, mention them to your care team
• Ask about your exact fever threshold and when to call — each treatment plan may have specific instructions

Diagnosis

Your doctor will ask about your symptoms, check your temperature, and examine you. They will likely order blood tests to see your white blood cell count and check for signs of infection.

Tests that may be done

• Full blood count (to check white blood cells)
• Blood cultures (to find bacteria in your blood)
• Urine test
• Chest X-ray if you have cough or breathing symptoms
• Tests of samples from any line or catheter

What to expect at your appointment

You may need to go to the hospital for monitoring and treatment. Your medical team will start treatment quickly. Be prepared to answer questions about your symptoms and medical history.

Treatment

Treatment for fever during chemotherapy focuses on finding and treating the infection, supporting your immune system, and reducing fever. In most cases, you will be admitted to the hospital. The goal is to deliver care as soon as possible to prevent complications.

Self-care at home

• While you are waiting for medical help, drink plenty of fluids
• Rest — do not try to push through feeling unwell
• Use a light blanket if you have chills; dress comfortably if you feel hot
• Do not take any fever-reducing medicines or over-the-counter medications unless your oncology team tells you to
• Do not wait to see if the fever goes away — contact your team right away

Medical treatments

Your care team may give you antibiotics through an IV (drip), fluids, and medicines to help bring down the fever. They may also use medications to help your body make more white blood cells. These treatments are tailored to your needs and are given under close supervision. Do not stop any prescribed treatments without speaking to your doctor.

Living with this condition

During chemotherapy, check your temperature if you feel warm, feverish, or unwell. Keep a thermometer at home and know your care team's after-hours number. Write down any symptoms and when they started.

Lifestyle tips

• Wash your hands often with soap and water
• Avoid people who are sick or large crowds when your white blood cell count is low
• Take care of your skin and mouth — clean cuts and scrapes quickly
• Stay up to date on comfortable, gentle exercise if you feel up to it
• Ask your care team about activities that are safe for you

Diet and exercise

Eat a balanced diet with enough protein and calories to help your body recover. Avoid raw or undercooked meat, eggs, and unpasteurized dairy while counts are low. Do light activity like walking if you feel well, and rest when you are tired. Always check with your care team about any dietary restrictions.

Mental health and emotional wellbeing

Worrying about fever and infection is normal. You may feel anxious about every symptom. Talk to your care team about your concerns, and try deep breathing, relaxation exercises, or journaling. Remember that reaching out early is the best way to stay safe, and it is never a burden to your team. If you are having thoughts of harming yourself, call your local emergency number or a crisis line today.

Prevention

You cannot always prevent a fever during chemotherapy, but you can lower your risk by following good hand hygiene, avoiding close contact with sick people, and telling your care team right away if you notice any signs of infection.

Vaccines

Ask your care team which vaccines are safe for you while on chemotherapy. Some vaccines may be postponed or avoided. Also, remind family and close contacts to stay up to date on their own vaccines, especially flu and COVID-19.

Complications

If left untreated

• An untreated infection can spread to the bloodstream, a condition called sepsis
• Sepsis can cause organ failure
• It can be life-threatening

Long-term outlook

The outlook is very good when fever is treated promptly. Most people with fever during chemo recover fully and can continue their cancer treatment. The key is to act fast and work closely with your medical team.

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