The doctor will ask questions about past medical problems, review all medications the patient is taking, and perform a thorough physical examination to determine the cause of fever. Patients who are suspected of having an infection, especially those who have neutropenia (a very low white blood cell count) and fever, will undergo very careful inspection of the skin, body openings (mouth, ears, nose, throat, urethra, vagina, rectum), needle stick sites, biopsy sites, and skin folds (for example, the breasts, armpits, or groin). The teeth, gums, tongue, nose, throat, and sinuses will be carefully examined. Any tubes that are inserted into veins or arteries or other tubes placed in the body, such as stomach tubes, are common sources of infection. Urine,sputum, and blood specimens will be examined for signs of infection. Patients with neutropenia may not show the usual symptoms of infection, so they should be examined frequently.
The symptoms of fever in very weakened cancer patients may include fatigue, muscle pain, sweating, and chills. Possible treatments to manage fever include those that treat the underlying cause, giving intravenousfluids, nutritional support, and other measures to make the patient more comfortable. The specific treatments are determined by the stage of cancer and the patient's goals for care. For example, some patients who are nearing the end of life may decide not to be treated for the underlying cause such as pneumonia or other infections, but may still request general comfort measures and fluids to maintain their quality of life. Other patients may choose antibiotics to relieve symptoms such as cough, fever, or shortness of breath that occur because of the infection. See the General Treatments to Relieve Fever section of this summary for more information.
Antibiotics may be used to treat fever caused by infection. Antibiotic therapyregimens and drugs to treat fungal infections are prescribed by the doctor. Fever caused by a tumor is usually treated by prescribing standard therapies for the specific type of cancer. If the therapy is not successful, the therapy takes awhile to work, or there is no therapy available, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs).
Sometimes fever may be caused by a reaction to drugs given to treat the cancer or prevent infection. Drugs that are known to cause fever include biological response modifiers, amphotericin B, and bleomycin. Suspected drug-related fever may be treated by stopping the drug that is causing the fever. When a biological response modifier, certain chemotherapy drugs, or antibiotics cause the fever, the doctor may control the fever by adjusting the type of drug, how the drug is given, the amount of drug given, or how often the drug is given. Acetaminophen, NSAIDs, and steroids may also be given before the patient receives the drug that causes the fever. Meperidine may be given to stop chills associated with a drug-related fever.