“Should a cancer patient be kept in the hospital when they have fever?”

Cancer by itself is an inflammatory condition, and can cause unexplained fevers. Whenever anyone complains of unexplained fevers off and on over a course of several months, one of the differential is cancer. However, once you have a diagnosis of cancer and have fevers after chemotherapy treatment, it is very important you talk to your oncologist about this. In most chemotherapy, if you develop fevers shortly after chemotherapy, our concern is an infection. With the chemotherapy already in the system, the immune system will be weakened and unable to fight the infection. Most patients will be admitted and given broad spectrum antibiotics. Blood tests and imaging studies will be performed to look for a source of infection. Depending on the patient's immune system functioning, they may get shots to boost their immune system. There will be some cases where, after a few days in the hospital, there will be no source of infection that we can find. In that case, the patient may be sent home with antibiotic tablets to take at home.

If the fever is determined to be from the cancer itself or a blood clot then no. If the fever is from an infection they should find the source and start appropriate antibiotics first and they can be discharge once they show improvement which often implies resolution of fever.

Yes esp if his neutrophil count is low

Often times a patient can develop fever related to cancer or treatment of cancer. The important thing to consider is if they are neutropenic(low white blood cell count) and if they are experiencing any other symptoms. Patients who are neutropenic are unable to manifest the typical immune response required to fight infection and often times don't have symptoms related to an underlying infection. These patients should at least report to the emergency department and be screened for pneumonia, urinary tract infection, abdominal infection(colitis), and bacteremia(blood cultures). a lot of time they will be started on an antibiotic called cefepime while they are being worked up. If all tests come back negative the patient can go home but typically they should have improvement in their white blood count level first which can be aided with a medication called neupogen in select circumstances. If the patient has normal white blood cell count and the initial sceen for infection is negative often time they will be released from the emergency department home.

Hope this helps,

Jack Stephens, MD