When you receive chemotherapy for breast cancer, you will most likely run out of white blood cells called neutrophils. Doctors call this neutropenia. It’s a normal part of chemo.
With neutropenia, you are more likely to have infections and fever. This is because neutrophils are part of your body’s frontline immune response. So, with fewer of them available to fight threats, you are more vulnerable.
Remember that neutropenia is a temporary side effect of chemotherapy and there are simple precautions you can take to avoid getting an infection.
Ways to Help Prevent Infection During Neutropenia
Do these things to protect yourself:
- Get all your vaccines recommended by your doctor. This includes the flu vaccine and the COVID-19 vaccine and boosters. Ask about other vaccines, such as hepatitis B and pneumonia. If you are receiving chemotherapy, your immune system needs help, regardless of your age.
- Wash your hands often.
- Avoid contact with people you know are sick. Do this even if he says he feels fine or is no longer contagious.
- Avoid busy indoor spaces. “If you have to go to an indoor place like the church or the grocery store, wear a mask and limit the time you spend there as much as possible. I would even suggest wearing a mask if you’re attending a crowded outdoor event,” says Jeremy Papacena, PharmD, clinical pharmacy specialist in hematology and oncology at the Allegheny Health Network in Pennsylvania.
- Prepare your food carefully. Cook food well. “Avoid having rarer meats or things like sushi or other uncooked fish, and wash and scrub raw fruits and vegetables,” Papacena says.
- Ask people to protect you. Ask family members and others who live with you to follow similar precautions as much as possible.
You do not have to take your temperature every day during chemotherapy. But if you notice any symptoms of infection — such as feeling flushed or cold, shortness of breath, or feeling weak or unwell — talk to your doctor.
If you develop a fever during chemotherapy, call your doctor immediately and explain your symptoms.
“They might tell you everything is fine, or they might want you to go to your doctor’s office or the nearest emergency department,” says Nan Chen, MD, a breast cancer specialist at the University of Chicago. . “If you go to the ER, make sure you tell the doctor you’re on chemotherapy.”
How long does breast cancer neutropenia last?
The severity of neutropenia and its duration vary. It partly depends on the type of chemotherapy you receive, Papacena says.
“Most people see their lowest points of neutropenia somewhere around the middle of their treatment cycle,” Papacena says. “If you are receiving chemotherapy every 4 weeks, your neutropenia will usually be at its lowest about 2 weeks after the last treatment. It can definitely get worse as treatment continues.
Treatments for breast cancer neutropenia
The main treatments that doctors use to help shorten neutropenia and protect you from infections are drugs called G-CSF (granulocyte-colony stimulating factors). You usually receive them by injection about 24 hours after a dose of chemotherapy.
“If we give chemotherapy that has a moderate or high risk of leaving you neutropenic for several days, we will give you G-CSF drugs after chemotherapy to increase your white blood cells,” says Chen.
For most people who receive chemotherapy that can cause neutropenia, doctors prescribe long-acting G-CSF drugs. With long-acting G-CSF drugs, you only need to have one injection after each chemotherapy treatment. You can either return to the cancer center where you received your chemotherapy for your injection the next day, or self-inject the drug at home (or have a partner inject it for you).
A newer option for delivering long-acting G-CSFs is called Onpro. It comes in a kit with a pre-filled syringe inside a blister pack that is applied to your skin (usually on your upper arm). Your healthcare provider prepares an area of skin and applies the injector pack to the body. They will insert a short needle that will inject the medicine under your skin about 27 hours later.
“Once the injector is activated, it will slowly deliver the drug over about 45 minutes,” Papacena explains. “You have to be careful not to accidentally drop it or take it off too soon so you don’t get a full dose of the drug. There’s a cute little “fuel gauge” on the package so you know when the medicine is fully dispensed. When it says “empty”, you can remove it and throw it away.
“If you’re not comfortable using a needle yourself and don’t want to have to go back to the doctor the next day for an injection, this is a good option,” Chen says. .
There are also shorter-acting G-CSF drugs that require multiple injections between doses of chemotherapy.
“These have mostly fallen out of favor with the availability of longer-acting drugs that only require a single injection,” Papacena says. “But some patients might have more serious side effects with the longer-acting agents, and for them we might try the shorter-acting drugs.”
The most common side effects of G-CSFs are usually bone and muscle pain and mild fever. “Usually these can be managed by taking a nonsteroidal anti-inflammatory drug, or even an over-the-counter anti-allergy medication,” Chen says.
Why breast cancer neutropenia occurs
Chemo is powerful medicine that doesn’t just affect your cancer.
“Chemotherapy works against cancer cells because it’s designed to kill cells that are rapidly dividing, like cancer cells,” Chen says. “But some of the healthy cells in your body also divide rapidly, including white blood cells called neutrophils which are very important in the body’s defense against infection.”
When bacteria or viruses enter your body, “neutrophils are among the first cells to react, rapidly dividing to trigger an immune response,” says Chen. “So they’re very vulnerable to drugs that kill rapidly dividing cells.”
Remember that this is to be expected with chemo. “Neutropenia tends to follow a fairly typical pattern, and your doctor will know how to manage it,” Chen says.