The definition of fever is flexible and depends on the clinical context. Fever is
frequently observed in patients with cancer.
Methods
Infectious and noninfectious causes of fever in patients with various oncological and
hematological malignancies and the usefulness of biomarkers are discussed.
Results
To treat patients in a timely manner and to minimize morbidity and mortality, it is
paramount that health care professionals determine the cause of fever. The usefulness of
biomarkers in febrile patients with cancer continues to be controversial.
Conclusions
Fever is frequently seen in patients with cancer and can be associated with a variety
of infectious and noninfectious causes. The utility of acute-phase reactants, such as
erythrocyte sedimentation rate, C-reactive protein, and procalcitonin, along with a
nonsteroidal anti-inflammatory drug challenge should be further evaluated as adjunct
tools for the workup of fever in patients with cancer.
References
1.
MacLarenG.,
SpelmanD.Fever in the intensive care unit. In:
ManakerS.,
FinlayG., eds.
UpToDate.Waltham, MA: Wolters
Klewer; 2017.
2.
O'GradyN.P.,
BarieP.S.,
BartlettJ.G.Guidelines for evaluation of new fever in critically ill adult patients:
2008 update from the American College of Critical Care Medicine and the Infectious
Diseases Society of America.Crit Care Med.2008; 36(4):
1330–1349.
3.
ToussaintE.,
Bahel-BallE.,
VekemansM.Causes of fever in cancer patients (prospective study over 477
episodes).Support Care Cancer.2006; 14(7):
763–769.
4.
ChangJ.C.,
GrossH.M.Neoplastic fever responds to the treatment of an adequate dose of
naproxen.J Clin Oncol.1985; 3(4):
552–558.
5.
ZellJ.A.,
ChangJ.C.Neoplastic fever: a neglected paraneoplastic syndrome.Support Care Cancer.2005; 13(11):
870–877.
LiawC.C.,
HuangJ.S.,
ChenJ.S.Using vital sign flow sheets can help to identify neoplastic fever and
other possible causes in oncology patients: a retrospective observational
study.J Pain Symptom Manag.2010; 40(2):
256–265.
8.
ChangJ.C.,
GrossH.M.Utility of naproxen in the differential diagnosis of fever of undetermined
origin in patients with cancer.Am J Med.1984; 76(4):
597–603.
9.
VanderschuerenS.,
KnockaertD.C.,
PeetermansW.E.Lack of value of the naproxen test in the differential diagnosis of
prolonged febrile illnesses.Am J Med.2003; 115(7):
572–575.
Anti-thymocyte globulin (rabbit) [package
insert]. In. Cambridge, MA:
Genzyme; March 2016.
16.
LiG.N.,
WangS.P.,
XueX.Monoclonal antibody-related drugs for cancer therapy.Drug Discov Ther.2013; 7(5):
178–184.
17.
Rituximab [package insert].South San Francisco, CA:
Biogen; Genentech; April
2016.
18.
Panitumumab [package insert].Thousand Oaks, CA: Amgen;
March 2015.
19.
Filgrastim [package insert].Thousand Oaks, CA: Amgen;
June 2016.
20.
Sargramostim [package insert].In. Bridgewater, NJ:
sanofi-aventis; April
2013.
21.
TanvetyanonT.,
StiffP.J.Management of the adverse effects associated with intravenous
bisphosphonates.Ann Oncol.2006; 17(6):
897–907.
22.
FreifeldA.G.,
BowE.J.,
SepkowitzK.A.Clinical practice guideline for the use of antimicrobial agents in
neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of
America.Clin Infect Dis.2011; 52(4):
e56–e93.
23.
OizumiK.,
OnumaK.,
WatanabeA.Clinical study of drug fever induced by parenteral administration of
antibiotics.Tohoku J Exp Med.1989; 159(1):
45–56.
24.
RolstonK.V.Neoplastic fever: all who shiver are not infected.Support Care Cancer.2005; 13(11):
863–864.
KandaJ.,
KaynarL.,
KandaY.Pre-engraftment syndrome after myeloablative dual umbilical cord blood
transplantation: risk factors and response to treatment.Bone Marrow Transplant.2013; 48(7):
926–931.
28.
MarkandayA.Acute phase reactants in infections: evidence-based review and a guide for
clinicians.Open Forum Infect Dis.2015; 2(3):
ofv098.
29.
SchuttrumpfS.,
BinderL.,
HagemannT.Utility of procalcito-nin concentration in the evaluation of patients with
malignant diseases and elevated C-reactive protein plasma
concentrations.Clin Infect Dis.2006; 43(4):
468–473.
30.
KallioR.,
BloiguA.,
SurcelH.M.C-reactive protein and eryth-rocyte sedimentation rate in differential
diagnosis between infections and neoplastic fever in patients with solid tumours and
lymphomas.Support Care Cancer.2001; 9(2):
124–128.
31.
GilbertD.N.Use of plasma procalcitonin levels as an adjunct to clinical
microbiology.J Clin Microbiol.2010; 48(7):
2325–2329.
32.
PenelN.,
FournierC.,
ClisantS.Causes of fever and value of C-reactive protein and procalcitonin in
differentiating infections from para-neoplastic fever.Support Care Cancer.2004; 12(8):
593–598.
33.
ShomaliW.,
HachemR.,
ChaftariA.M.Can procalcitonin distinguish infectious fever from tumor-related fever in
non-neutropenic cancer patients?Cancer.2012; 118(23):
5823–5829.
34.
LeeH.Procalcitonin as a biomarker of infectious diseases.Korean J Intern Med.2013; 28(3):
285–291.
