Using Vital Sign Flow Sheets Can Help to Identify Neoplastic Fever and Other Possible Causes in Oncology Patients: A Retrospective Observational Study

Abstract 

Context

It is important to determine the etiology of fever in cancer patients. Such patients often undergo extensive laboratory and radiographic investigations and prolonged anti-infective therapy that are time- and resource- consuming, risk drug toxicity, and postpone systemic chemotherapy.

Objectives

To investigate neoplastic fever (NF) patterns from vital sign flow sheets.

Methods

Between September 1997 and February 2009, data on 150 consecutive hospitalized patients with advanced or metastatic solid tumors documented to have NF were retrospectively collected. Sixty patients with sepsis were used as a comparison group.

Results

All patients with NF demonstrated intermittent fever patterns. Peak body temperature was 39.0±0.6°C (38.0–40.8°C). Baseline pulse rates in 139 (93%) patients showed no increase except during febrile periods. The remaining 11 (7%) patients had transiently elevated baseline pulse rates at the time of cessation of postchemotherapy dexamethasone. Once-daily fever spike patterns occurred in 108 (72%) patients. Fever spikes were most commonly found at 9 am (42%) and 5 pm (37%). Twice-daily fever spike patterns were noted in the 42 (28%) remaining patients. In the comparison group, baseline pulse rate elevated in all patients during febrile periods and 20 (33%) showed intermittent fever patterns.

Conclusion

We conclude that the NF pattern is characterized by intermittent fever without an obvious increase in baseline pulse rate except during febrile periods. Knowing NF patterns from vital sign flow sheets can help identify NF and other possible causes of fever in oncology patients.

Key Words: Neoplastic fever, vital sign flow sheets, intermittent fever, pulse rate, oncology patients