Introduction

Patients with advanced or terminal cancer are at high risk for infections as a result of the underlying disease, a poor nutritional state, and/or a direct suppression of the hematological system due to chemotherapy or radiation treatments. An infectious complication may occur due to an alteration in the phagocytic, cellular, or humoral immunity, an alteration or breach of their skin or mucosal defense barriers, indwelling catheters, or a splenectomy. A high index of suspicion, a consideration of the empirical institution of antimicrobials, an awareness of the possibility of unusual infectious agents, and a constant surveillance of the hematological status of the patients are necessary in order to provide optimal management of infections in this patient population.

This review will consider the initial evaluation of fever, the use of antimicrobial agents, the predominant organisms associated with infection, and the management of infectious complications in this specific patient population. Special consideration and discussion will be given to patients receiving hospice and palliative care.

Evaluation of fever

In patients with advanced cancer, fever is very common and it may or may not have an infectious etiology. It must be noted that fever may be the only manifestation of an infection in an immunocompromised patient and there is no pattern of fever that can be used to definitively rule out an infectious etiology. Fever may also be modified by the use of specific medications such as corticosteroids or nonsteroidal anti-inflammatory agents.