|
Table of Contents Introduction
Fever
Sweats
Get More Information From NCI
Changes to This Summary (09/26/2008)
Questions or Comments About This Summary
About PDQ
Introduction
This patient summary on fever, sweats, and hot flashes is adapted from a
summary written for health professionals by cancer experts. This and other
credible information about cancer treatment, screening, prevention, supportive
care, and ongoing clinical trials, is available from the National Cancer
Institute. Fever is a rise in body temperature above the normal temperature.
In a person who has cancer, fever may be caused by infection, a tumor, drug reactions, or blood transfusion reactions. Sweating is the body's way of
decreasing body temperature by causing heat loss through the skin and, in a
person who has cancer, may be associated with fever, a tumor, or cancer
treatment. Hot flashes can also cause excessive sweating and may occur in
natural menopause or in patients who have been treated for breast cancer or prostate cancer. This brief summary describes the causes and treatment for
fever, sweats, and hot flashes.
Back to Top Fever
Overview
Normal human body temperature changes during each 24-hour period according to a
definite pattern. It is lowest in the morning before dawn and highest in the
afternoon. Normal body temperature is maintained by temperature control
activities in the body that keep a balance between heat loss and heat
production.
An abnormal increase in body temperature is caused by either hyperthermia (an
unusual increase in body temperature above normal) or fever. Hyperthermia is
caused by a breakdown in the body's temperature control activities. In fever,
the temperature controls in the body are working correctly, but body
temperature increases as the body responds to chemicals produced by microorganisms that cause infection or works to kill harmful microorganisms such as bacteria or viruses. There are three phases to fever. In the first phase, the
body raises its temperature to a new level by causing the blood vessels in the
skin to constrict and move blood from the skin surface to the interior of the
body which helps to retain heat. The skin becomes cool, the muscles contract
causing shivering or chills, and the body produces more heat. The body's
efforts to retain and produce heat continue until a new higher temperature is
reached. In the second phase, heat production and heat loss are equal,
shivering stops, and the body maintains the new higher temperature. In the
third phase, body temperature is lowered to normal as the body gets rid of the
excess heat by causing the blood vessels in the skin to open and move blood
from the interior of the body to the skin surface. Sweating occurs and helps
to cool the body.
Fever is most likely to cause harmful effects in older persons or the very young.
In older persons, the hypothalamus' temperature regulating centers do not work
as well and the body temperature may rise above normal causing irregular
heartbeat, lack of blood flow, changes in the ability to think clearly, or
heart failure. Children between 6 months and 6 years old may have seizures due to a fever.
Description and Causes
The main causes of fever in cancer patients are infections, tumors,
reactions to drugs or blood transfusions, and graft-versus-host-disease.
Graft-versus-host-disease occurs when transplanted bone marrow or peripheral
stem cells attack the patient's tissue. Infection is a common cause of fever
in cancer patients and can cause death. Tumor cells can produce various substances
that can cause fever. A wide variety of medications can
cause fever including chemotherapy drugs, biological response modifiers, and antibiotics, such as vancomycin and amphotericin.
Other causes of fever in cancer patients include drug withdrawal; neuroleptic
malignant syndrome; blockages of the bladder, bowel, or kidney, and blockage of
an artery by tumor fragments. Other medical conditions occurring at the same
time as the cancer such as blood clots, connective tissue disorders, and central nervous system hemorrhage or stroke, may also cause fever.
Assessment
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.
Treatment
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 intravenous fluids, 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.
Antibiotics may be used to treat fever caused by infection. Antibiotic therapy regimens 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.
Neuroleptic malignant syndrome (NMS) is a rare but sometimes fatal reaction to
drugs that a patient is given for psychotic conditions, delirium, or nausea and vomiting. The symptoms of NMS are fever, muscle stiffness, confusion, loss of
control of body functions, and an increase in white blood cell count. A
delirious patient who does not improve when treated with medication should be
examined for NMS. Treatment for NMS includes stopping the drug, treating the
symptoms, and sometimes using other drugs. (Refer to the PDQ summary on Cognitive Disorders and Delirium for more information.)
Cancer patients may develop a fever as a reaction to blood products (for
example, receiving a blood transfusion). Removing white blood cells from the
blood or treating the blood product with radiation before transfusing it into
the patient can lessen the reaction. The possibility of fever due to receiving
blood products can also be lessened by giving patients acetaminophen or
antihistamines before the transfusion.
General Treatments to Relieve Fever
Along with treatment of the underlying cause of fever, comfort measures may
also be helpful in relieving the discomfort that goes along with fever, chills,
and sweats. During periods of fever, giving the patient plenty of liquids,
removing excess clothing and linens, and bathing or sponging the patient with
lukewarm water may give relief. During periods of chills, replace wet blankets
with warm, dry blankets, keep the patient away from drafts, and adjust the room
temperature to improve patient comfort.
Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen may also be
prescribed to relieve symptoms. Aspirin may be effective in decreasing fever,
but should be used with caution in patients with Hodgkin lymphoma and cancer
patients who are at risk for developing a decrease in the number of platelets in the blood. Aspirin is not recommended in children with fever because of the
risk of developing Reye syndrome.
Back to Top Sweats
Overview
Sweat is made by sweat glands in the skin. Sweating helps to keep the body
cool and can occur with disease or fever, when in a warm environment,
exercising, or as part of hot flashes experienced with menopause. Most breast cancer and prostate cancer patients report having moderate-to-severe
hot flashes. Distressing hot flashes seem to be less frequent and gradually
decrease with time in most postmenopausal women who do not have
breast cancer. In breast cancer survivors, however, hot flash intensity does
not decrease with time. Most men with prostate cancer who have had surgery to
remove the testicles experience hot flashes.
Causes
Sweats in the cancer patient may be associated with the tumor, cancer
treatment, or other medical conditions that are not related to the cancer.
Sweats are a typical symptom of certain types of tumors such as Hodgkin lymphoma, pheochromocytoma, or tumors involving the nervous system and endocrine
system. Sweats may also be caused by:
Treatments
Sweats
Treatment of sweats caused by fever is directed at the underlying cause of the
fever. (Refer to the fever Treatment section for more information.) Sweats
caused by a tumor are usually controlled by treatment of the tumor.
Hot flashes
Hot flashes associated with natural or treatment-related menopause can be
effectively controlled with estrogen replacement. Many women are not able to
take estrogen replacement (for example, women with breast cancer). Hormone replacement therapy that combines estrogen with progestin may increase the risk of breast cancer or breast cancer recurrence.
Studies of non-estrogen drugs to treat hot flashes have reported that many of them are not as effective as estrogen replacement or have
unwanted side effects. The most effective of these include megestrol (a drug similar to progesterone) and certain antidepressants, including venlafaxine. It is important to know that some antidepressants may change how other drugs, such as tamoxifen, work in the body. Soy and black cohosh have not proven to be helpful in relieving hot flashes. Soy contains estrogen-like substances; the effect of soy on the risk of breast cancer growth or recurrence is not clear.
Relaxation training has been found to decrease
hot flash discomfort in postmenopausal women who are in general good health.
Treatment of hot flashes in men may include estrogens, progesterone, and antidepressants. Certain hormones (such as estrogen) can make some cancers grow. The effect of hormone use on the growth of prostate cancer is being studied.
General Treatments to Relieve Symptoms
A variety of other medications are being used for general treatment of
cancer-related sweats. The use of loose-fitting cotton clothing, fans, and
behavioral techniques such as relaxation training is also recommended.
Back to Top Get More Information From NCI
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Chat online
The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
Back to Top Changes to This Summary (09/26/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Back to Top Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Back to Top |
