Fever in cancer patients as a cause of attendance in emergency room

Abstract

e20706 Background: Normal human body temperature displays a circadian rhythm, ranging from 36.1 C or lower in predawn hours to 37.4 C or higher in the afternoon. Abnormal elevation of temperature occurs as a result of hyperthermia or fever. Cancer patients frequently experience fever. Nearly two-thirds of the cases of fever in patients with prolonged neutropenia could be attributed to infection, a major cause of morbidity in cancer patients. Purpose: The aim of our study is to evaluate the prevalence of cancer patients who were attended in the emergency room for fever, the diagnosis and clinical management. Methods: From October 2007 to October 2008, 560 cancer patients were seen in the emergency department of the University Hospital of Zaragoza. The purpose of this paper is to describe the characteristics of patients who presented with fever. Results: A total of 560 patients were seen. Ninety-eight (17.5%) presented with fever. 63% of patients were stage IV. Cancer tumor type, 35 had lung cancer (35.7%), 14 had breast cancer (14.3%), 9 had colorectal cancer (9.2%), 9 had urothelial cancer (9.2%), 5 had head neck cancer (5.1%), 5 had pancreatic cancer (5.1%), 3 had esophageal cancer (3%), 2 had prostate cancer (2%), and 14,3% had other neoplasm. 18 patients (18.36%) had been received chemotherapy treatment in a period of 10 days before. they were attended in emergency room. By diagnosis: 23 patients (23,46%) were diagnosed of febrile neutropenia, and 19 of them (82,6%) required admission to the hospital. 30 were diagnosed of respiratory tract infection (30,6%), 12 were diagnosed of urinary infection (12.24%). Considering all the patients who presented with fever: 45 patients were sent home with new treatment (45,9%), 6 patients were observed for 24 hours in the emergency room (6.2%) and 47 patients required admission to the hospital (47.9%). Conclusions: Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. Infection in the immunocompromised host is a serious clinical situation due to high morbimortality and is one of the most frequent complications in the patient with cancer. No significant financial relationships to disclose.