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Infection Risks for Cancer Patients and How to Avoid Them


Imagine this scenario: You've been diagnosed with cancer and just had your first round of chemotherapy. About seven days later you come down with a fever and an infection that requires you to be hospitalized. Unfortunately, this setback means your next round of chemotherapy is delayed until your immune system bounces back.

Patient at the hospital.

This situation is common for cancer patients receiving chemotherapy treatment and should be treated as an emergency. Normally, your immune system might have been able to fight off this infection, but when you are undergoing chemotherapy, it kills both the cancer cells and the healthy white blood cells that make up your immune system.

The good news is that there are things you can do to help minimize your risk of infection. The first thing to do is understand when you're most at risk.

Timing Is Everything
Your highest risk of getting an infection is usually about seven to 12 days after you finish each chemotherapy dose and can last up to one week. Ask your doctor or nurse when your "high risk" days will be (aka, when your white blood cell count will likely be at its lowest).

This period of time is sometimes referred to as the nadir, which means "lowest point." During this time be extra careful and take your temperature every evening, and call your doctor if you have a temperature of 100.4ºF or higher.

Other Risk Factors
It's also important to know that there are other factors that may put you at a greater risk for infection. Here are some examples:

* You are 65 years or older.
* You are female.
* You are unable to take care of yourself without assistance or are bedbound.
* You have lost a lot of weight in a short time (unintentional weight loss).
* You have another condition that makes it more difficult to fight off infections (e.g., diabetes, kidney disease, high blood pressure, congestive heart failure, autoimmune disease, liver disease, chronic bronchitis or emphysema).
* You have a type of cancer (leukemia, for example) that affects the blood or lymph nodes.
* Your cancer has spread to other parts of the body.
* You have had chemotherapy or radiation in the past.
* You are receiving more than one chemotherapy drug.
* The chemotherapy that you are receiving affects the bone marrow. Not all chemotherapy causes a low white blood cell count. Ask your doctor or nurse about what types you are receiving and which ones cause a low white blood cell count.
* Your doctor or nurse has told you that you have a low white blood cell count in the past.

You can also visit PreventCancerInfections.org and take the assessment to find out what your level of risk is.

 Take Control
Even if you checked off every risk factor listed above, there are still plenty of things you can do to help prevent infection, in addition to receiving treatment from your doctor.

* Wash your hands frequently.
* Avoid crowded places and contact with people who are sick.
* Don't share food, drinking cups, utensils or other personal items, such as toothbrushes.
* Shower or bathe daily and use an unscented lotion to prevent your skin from becoming dry.
* Cook meat and eggs thoroughly to kill any germs.
* Carefully wash raw fruits and vegetables.
* Protect your skin from direct contact with pet waste (urine or feces) by wearing vinyl or household cleaning gloves when cleaning up after your pet. Wash your hands immediately afterwards.
* Use gloves for gardening.
* Clean your teeth and gums with a soft toothbrush, and if your doctor or nurse recommends one, use a mouthwash to prevent mouth sores.
* Try to keep all your household surfaces clean.
* Get the seasonal flu shot as soon as it is available.

The Top Five
I'm often asked, "What is the number one thing you tell your patients who are undergoing chemotherapy treatment?" While I can't pinpoint just one recommendation, here are my top five:

1. Keep your hands clean
2. Treat a fever as an emergency, and call your doctor right away if you get one (>100.4ºF).
3. Know the signs and symptoms of an infection.
4. Take medication as prescribed
5. Get a flu shot

-- Dr. Richardson

Readers -- Have you ever suffered an infection during a serious illness? Do you know the signs and symptoms of an infection? Do you get an annual flu shot? If not, why? Leave us a comment below and let us know.

Lisa C. Richardson, M.D., M.P.H., is a medical officer and the Director of the Division of Blood Disorders (DBD) at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.  She is also a lead investigator of CDC's Preventing Infections in Cancer Patients program.  Dr. Richardson most recently served as the Associate Director of Science in the Division of Cancer Prevention and Control in the National Center for Chronic Disease Prevention and Health Promotion. She oversaw the research and scientific content of the Division's programs and products including the only organized screening program for low-income uninsured women in the United States, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

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