Treatment for fever in patients with cancer

Condition analysis:
Cancer fever classically is associated with Hodgkin’s lymphoma, but can occur in the setting of non-Hodgkin’s lymphoma, leukemia, and solid tumors. Some specific solid malignancies that result in tumor fever include renal cell carcinoma (by elaboration of interleukin-6), hepatocellular carcinoma, pancreatic carcinoma, bronchogenic carcinoma, and brain tumors. A unique benign tumor which may present with fever is atrial myxoma, a tumor notorious for releasing cytokines which cause constitutional symptoms. A good rule of thumb, however, is to consider cancer of any type in a patient with prolonged fever and no evidence of infectious illness.

Instruction:
1. Supportive Care:
General medical care should be offered to the cancer patient with fever and typically includes intravenous fluids to replace insensible water loss from pyrexia, pain control, venous thromboembolism prophylaxis, nutrition support, and physical therapy. This should all be done simultaneously with fever evaluation.

2. Antipyretic Therapy
Fever is a normal host response to inflammation and infection and may confer an immunologic benefit, especially in patients with bacterial infection. Nonetheless, anti-pyretic therapy with acetaminophen, aspirin, or NSAIDS may be considered in certain situations. First, if a patient requests fever suppression for comfort, it should be provided. Another indication for treatment of fever is the potential adverse effects of fever-induced insensible water loss and increased metabolic demands in ill patients with multiple co-morbidities, especially the elderly. In addition, sinus tachycardia from fever can lead to decreased filling of the ventricle and result in congestive heart failure in patients with limited cardiac reserve. In general, acetaminophen is the agent with the most favorable side-effect profile since it lacks gastropathic and nephrotoxic effects at clinical doses, although caution should be exercised in patients with significant liver disease.