Introduction

Almost all have experienced fever and the associated chills and sweats. Sweating also occurs independently of fever in various disease states, in normal situations like exercise and in common nondisease states such as menopause. Like other symptoms in advanced cancer, fever and sweats may be multifactorial, with different etiologies predominating at different points in the disease trajectory. Optimal management is predicated on an understanding of the contributing causes and pathophysiologic mechanisms, as well as knowledge of patient goals relative to the disease course.

Fever

Pathophysiology

In normal individuals, core body temperature is maintained within a tightly controlled range by a dynamic balance of heat production, heat conservation, and heat loss. There are three phases of fever. In the initiation phase, endogenous or exogenous pyrogens elevate the thermoregulatory set point above normal. Cutaneous vasoconstriction promotes heat retention and shivering produces additional heat. Behaviorally, the individual feels cold and seeks warmer clothing. When steady state fever is achieved, heat production balances heat loss and shivering ceases. During defervesence, the set point decreases to the normal core temperature and heat loss prevails. Heat loss occurs as a consequence of cutaneous vasodilation and sweating, with radiant and evaporative heat loss to the environment, respectively. There is a paucity of data describing the symptom complex associated with fever in the cancer patient.

Definition

Most oncologists consider a temperature in excess of 38.5 °C or 38 °C on three occasions at least 1 hour apart as clinically significant.