Febrile Neutropenia

Ask an Expert: Febrile Neutropenia Explained

Introduction:

Febrile neutropenia, or FN, is a common and potentially serious side effect of chemotherapy treatment.

Neutrophils are a type of white blood cell responsible for helping fight germs and infections. Neutropenia means that there are fewer neutrophils than normal in your blood and many people with lymphoma have neutropenia at some point during treatment[i]. Febrile neutropenia means that you have a fever AND a very low neutrophil count in your blood.

The primary symptom of FN is an elevated temperature of more than 38 degrees centigrade. Fever is often the first sign of infection and if the neutrophil count is very low, there is a greater chance of serious infection compared to having a fever with a normal or near-normal neutrophil count. All patients should have clear instructions on who to call and what to do in case a fever develops while on chemotherapy. The only way to know if a patient has FN is for a blood test to be done at the time of a fever.

Other symptoms that may occur as a result of FN and increase the risk of complications can include[ii]:

  • Chills
  • Sweating
  • Cough or shortness of breath
  • Sore throat or sores in your mouth
  • Redness or swelling around sores on your skin or redness and swelling of your skin
  • Trouble urinating and/or increased frequency or burning with urination
  • Vaginal discharge or itching
  • Flu-like symptoms such as body aches and extreme tiredness

Here, we ask three experts to explain FN, what it is, how it can impact treatment outcomes, and how it can be effectively managed. Our experts are:

Dr. Rayson
Dr. MacDonald
Dr. Younus

Dr. Daniel Rayson, MD, FRCPC
Oncologist, QEII Health Sciences Centre
Halifax, Nova Scotia

Dr. David MacDonald, MC, FRCPC
Hematologist, QEII Health Sciences Centre
Halifax, Nova Scotia

Dr. Jawaid Younus, MD, FRCPC
Oncologist, London Health Sciences
London, Ontario

What causes FN?

FN can arise as a consequence of most chemotherapy regimens across all cancer types. The risk of developing FN depends mostly on the intensity of the chemotherapy treatment and the health of the patient’s bone marrow which is where neutrophils are produced. The elderly and those who are sick from their cancer or other medical conditions are most susceptible to complications from FN.

– Dr. Rayson

How common is FN?

I often see FN in my practice, and it is more common than the published rates suggest. The good news is that it can be treated and sometimes the risk can be reduced with medication.

– Dr. MacDonald

How does FN impact a patient’s prognosis and their course of treatment?

FN can impact a patient due to the need to delay treatment to allow the neutrophil count to recover. If someone has a complication or a serious infection due to FN, treatment may have to be changed or stopped altogether. In general, results from treatment are optimal when chemotherapy can be given at the original dose and on the planned schedule. Neutropenia and FN can cause both dose and schedule changes that have the potential to impact treatment results in some cases.

– Dr. Rayson

When a patient is at high-risk of developing FN or develops FN during treatment, their doctor will prescribe medicines to reduce the risk of infection, such as a G-CSF or antibiotics. These may help to maintain the patient’s planned chemotherapy regimen. If the patient remains at high-risk of developing FN despite these measures, their doctor may need to adjust the patient’s chemotherapy treatment, potentially delaying the patient’s recovery.

– Dr. Younus

In my practice, for instance, if a patient remains neutropenic or they are still on antibiotics because they have had neutropenia or an infection, we give them a week off their chemotherapy and we reassess them a week later. Therefore FN can have an impact delaying a patient’s chemotherapy schedule.

– Dr. MacDonald

How is FN identified and treated?

It is crucial to be properly monitored by your healthcare team when receiving chemotherapy to watch for signs of FN. During the course of treatment patients should expect to have routine blood tests to measure levels of white blood cells[iii].

When a patient presents with a fever accompanied by symptoms of FN, healthcare professionals will take the patient’s medical history, administer a physical examination, take blood to measure the patient’s level of white blood cells (neutrophils), perform a chest x-ray and urine analysis to determine the site of infection. Patients may require routine injections of a drug that stimulates the growth and production of white blood cells and decreases the risk of FN. If necessary, antibiotics may also be used to treat the patient.

– Dr. Younus

Some patients are at a higher risk of developing FN so it’s important for chemotherapy patients to be closely monitored by their healthcare team and to watch for signs of FN. During the course of treatment, patients should expect to have routine blood tests to measure their levels of white blood cells. Typically though, cases of FN more are more prevalent among patients with certain types of cancers, such as aggressive lymphoma. People who have a history of chronic lung disease and urinary tract infections specifically are the ones to be concerned about and we want to treat them.

– Dr. MacDonald

When diagnosed with a low white blood cell (neutrophil) count, you may be more susceptible to germs and infection. It is important to report any signs of infection to your healthcare team. Below are a few tips to stay healthy during treatment.

Practice good personal hygiene

  • Wash your hands frequently, especially before eating and after going to the bathroom
  • Carry a small bottle of hand sanitizer to clean your hands if a sink is not available

Protect your skin

  • If your skin becomes dry or cracked, use moisturizing lotions to soften it and help it heal
  • Clean any cut or scrape at once with warm water and soap

Maintain good general health

Get enough rest, eat a well-balanced diet, drink plenty of fluids and get regular exercise

Cook vegetables and wash and peel fruit to get rid of bacteria on their surfaces. Avoid uncooked eggs, raw or undercooked meats, poultry, fish and seafood. These foods can contain harmful organisms[iv].

For more information about febrile neutropenia and the cancer journey, visit: https://www.lymphoma.ca/sites/default/files/documents/11-12-22%20FN%20Education%20Brochure_English_FINAL.pdf

This document was made possible with the support of Amgen Canada.

[i] http://www.lymphomas.org.uk/about-lymphoma/treatment/side-effects-of-lymphoma-treatments/neutropenia-and-risk-infection#neutropenia

[ii] http://www.cancer.net/navigating-cancer-care/side-effects/neutropenia

[iii] https://www.lymphoma.ca/sites/default/files/documents/11-12-22%20FN%20Education%20Brochure_English_FINAL.pdf

[iv] http://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/managing-side-effects/low-white-blood-cell-count/?region=bc