Fever, chills

You have a fever if your temperature taken in your mouth (oral temperature) is:

• 38.3°C (100.9°F) or higher at any time

            OR

• 38.0°C (100.4°F) or higher for at least one hour.

When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information.

What to look for?

• If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever.
• Do not take medications that treat a fever before you take your temperature (for example, Tylenol® (acetaminophen), or Advil® (ibuprofen)).
• Do not eat or drink anything hot or cold right before taking your temperature
• You may have fever, chills and muscle pain without any signs of infection, such as a sore throat, cough or skin rash.
• It may happen at any time after you receive your treatment and it usually goes away as your body gets used to the medication.

What to do?

If your health care team has told you that you have low neutrophils:

• Wash your hands often to prevent infection.
• Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist.
• Keep a digital thermometer at home so you can easily check for a fever.

If you have a fever:

If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.

Low platelets in the blood

When platelets are low, you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information.
 

What to look for?

• Watch for signs of bleeding:
  • bleeding from your gums
  • unusual or heavy nosebleeds
  • bruising easily or more than normal
  • black coloured stools (poo) or blood in your stools (poo)
  • coughing up red or brown coloured mucus
  • dizziness, constant headache or changes in your vision
  • heavy vaginal bleeding 
  • red or pink coloured urine (pee)

What to do?

If your health care team has told you that you have low platelets:

• Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication.
• Check with your healthcare team before you go to the dentist.
• Take care of your mouth and use a soft toothbrush.
• Try to prevent cuts and bruises.
• Ask your health care team what activities are safe for you.
• Your treatment may have to be delayed if you have low platelets. Your health care team may recommend blood transfusion.

If you have signs of bleeding:

• If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes.

If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.

Allergic reaction

(May be severe)

What to look for?

• Fever, itchiness, rash, swollen lips, face or tongue, chest and throat tightness.
• It may happen during or shortly after your treatment is given to you and may be severe.

What to do?

• Tell your nurse right away if you feel any signs of allergic reaction during or just after your treatment.
• Talk to your health care team for advice if you have a mild skin reaction.

Headache; mild joint, muscle pain or cramps 

What to look for?

• Mild headache
• New pain in your muscles or joints, muscle cramps, or feeling achy.
   

What to do?

• Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed.
• Read the above section: "What should I do if I feel unwell, have pain, a headache or a fever?" before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding.
• Rest often and try light exercise (such as walking) as it may help.

Ask your health care team for the Pain pamphlet for more information.

Liver problems

Your health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms.

What to look for?

• Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe.

What to do?

If you have any symptoms of liver problems, get emergency medical help right away.

Mild swelling

What to look for?

• You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe.
   

What to do?

To help prevent swelling:

• Eat a low-salt diet.

If you have swelling:

• Wear loose-fitting clothing.
• For swollen legs or feet, keep your feet up when sitting.

Cough and feeling short of breath

What to look for?

• You may have a cough and feel short of breath.
• Symptoms that commonly occur with a cough are:
  • wheezing or a whistling breathing
  • runny nose
  • sore throat
  • heartburn
  • weight loss
  • fever and chills
• Rarely this may be severe with chest pain, trouble breathing or coughing up blood.

What to do?

• Check your temperature to see if you have a fever. Read the above section "What should I do if I feel unwell, have pain, a headache or a fever?".
• If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
• If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away.

Rash; dry, itchy skin

What to look for?

• You may have cracked, rough, flaking or peeling areas of the skin.
• Your skin may look red and feel warm, like a sunburn.
• Your skin may itch, burn, sting or feel very tender when touched.

What to do?

To prevent and treat dry skin:

• Use fragrance-free skin moisturizer.
• Protect your skin from the sun and the cold.
• Use sunscreen with UVA and UVB protection and a SPF of at least 30.
• Avoid perfumed products and lotions that contain alcohol.
• Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less.

Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.

Cytokine release syndrome

(May be severe)

Cytokine release syndrome (CRS) can happen when your immune system releases a large amount of proteins called cytokines. This can make you very sick. If you have CRS, your health care team will need to do blood tests and monitor you more closely.

What to look for?

• Fever. Sometimes the fever can be high (more than 40ºC).
•  And, you may also have:
  • Chills 
  • New pain in your muscles or feeling achy 
  • Swelling in your hands, legs, ankles or feet 
  • Dizziness (sign of low blood pressure) 
  • Difficulty breathing 
  • Fast or irregular heartbeats 
  • Peeing less than usual
• CRS usually happens within minutes to hours of when treatment begins

What to do?

• Tell your nurse right away if you feel any signs of CRS during or just after your treatment.
• If you have left the hospital, check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?”
• If you have any signs of CRS, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away.

Low blood pressure

What to look for?

• You may feel tired, dizzy or light-headed.
• You may have nausea (feeling like you need to throw up), vomiting or blurred vision.
• You may faint (pass out).
   

What to do?

• Check your blood pressure often. Talk to your health care team to find out what a safe blood pressure is for you.
• If you feel dizzy or unwell lay down right away so that you do not fall. Try to get up and move slowly only once you feel better.
• Do not drive a motor vehicle or operate machinery if you feel dizzy.
• Your blood pressure may drop while you are on this medication. Let your health care team know right away if you start to feel dizzy or lightheaded.

Trouble Sleeping

Your medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends.
 

What to look for?

• You may find it hard to fall asleep or stay asleep.
• How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep.
• You may wake up too early or not feel well-rested after a night's sleep.
• You may feel tired or sleepy during the day.
   

What to do?

Talk to your health care team if it does not improve or if it is severe

Tremors (shaking)

What to look for?

• shaky movements in one or more parts of the body that you cannot control

What to do?