Tips for Managing Neutropenia

If you are receiving chemotherapy for breast cancer, you will most likely have a low number of white blood cells called neutrophils. Doctors call this neutropenia. It is a normal part of undergoing chemo.

Neutropenia makes you more likely to develop infections and fever. That’s because neutrophils are part of your body’s first-line immune response. So with fewer of them available to fend off threats, you are more vulnerable.

Keep in mind that neutropenia is a temporary side effect of chemo — and you can take simple precautions to avoid getting an infection.

Ways to Help Prevent Infection During Neutropenia

Do these things to protect yourself:

  • Get all your vaccinations that your doctor recommends. This includes the flu shot and the COVID-19 vaccine and boosters. Ask about other vaccines, such as those for hepatitis B and pneumonia. If you’re on chemotherapy, your immune system needs the help, regardless of your age.
  • Wash your hands often.
  • Avoid contact with people you know are sick. Do this even if they say they feel good or are no longer contagious.
  • Avoid crowded indoor spaces. “If you have to go to a covered place like the church or the supermarket, wear a mask and limit the time you are there as much as you can. In fact, I’d recommend wearing a mask if you’re at a busy outdoor event,” says Jeremy Pappacena, PharmD, a clinical pharmacy specialist in hematology and oncology at Allegheny Health Network in Pennsylvania.
  • Prepare your food carefully. Cook food thoroughly. “Avoid meats on the rarer side or things like sushi or other uncooked fish, and wash and scrub raw fruits and vegetables,” says Pappacena.
  • Let the people help protect you. Ask family members and others who live with you to take as many similar precautions as possible.

You do not need to take your temperature every day during chemotherapy. But if you notice any symptoms of infection, such as flushing or chilling, shortness of breath, or feeling faint or otherwise unwell, tell your doctor.

If you develop a fever while receiving chemotherapy, contact your doctor immediately and tell him your symptoms.

“They may tell you everything is fine, or they may want you to go to your doctor’s office or nearest emergency room,” says Nan Chen, MD, a breast cancer specialist at the University of Chicago. “If you go to the ER, tell the doctor there that you’re having chemotherapy.”

How long does neutropenia last in breast cancer?

How severe neutropenia is and how long it lasts varies. It depends in part on the type of chemotherapy you’re getting, Pappacena says.

“Most people see their lowest points of neutropenia somewhere in the middle of their treatment cycle,” Pappacena says. “If you get chemo every 4 weeks, your neutropenia is usually lowest about 2 weeks after the last treatment. It can certainly get worse as treatment continues.”

Treatments for Neutropenia in Breast Cancer

The main treatments doctors use to shorten neutropenia and protect you from infection are medications called G-CSFs (granulocyte colony-stimulating factors). You usually get them by injection about 24 hours after a dose of chemotherapy.

“If we give you chemotherapy with a moderate or high risk of leaving you neutropenic for many days, we will give you G-CSF medication after chemotherapy to increase your white blood cells,” Chen says.

For most people receiving chemotherapy that can cause neutropenia, doctors prescribe long-acting G-CSF drugs. With long-acting G-CSF medications, you only need to get one injection after each chemotherapy treatment. You can either go back to the cancer center where you received your chemotherapy the next day for your injection, or you can inject the medication yourself 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 containing a pre-filled syringe in a blister that is applied to your skin (usually on your upper arm). Your healthcare provider will prepare a section of skin and apply the on-body injector pack. They will insert a short needle that delivers the medicine under your skin about 27 hours later.

“Once the injector is activated, it will deliver the medication slowly over about 45 minutes,” Papacena says. “You have to be careful not to accidentally knock it off or take it off too quickly so you don’t get a full dose of the medication. There’s a nice ‘fuel gauge’ on the package so you know when the medication has been completely dispensed. When it says ‘Empty’, you can take it off and throw it away.”

“If you don’t feel comfortable using a needle yourself and don’t want to go back to the doctor the next day for an injection, this is a good option,” Chen says.

There are also short-acting G-CSF drugs that require multiple injections between doses of chemotherapy.

“Those have mostly fallen out of favor with the availability of longer-acting drugs that only require one injection,” Pappacena says. “But some patients may have more serious side effects with the longer-acting drugs, and for them we can try the short-acting drugs.”

The most common side effects of G-CSFs are usually bone and muscle pain and a low-grade 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 Neutropenia Occurs in Breast Cancer

Chemo is a strong drug that doesn’t just affect your cancer.

“Chemotherapy works against cancer cells because it is designed to kill cells that divide quickly, such as cancer cells,” Chen says. “But some of the healthy cells in your body also divide quickly, 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 one of the first cells to react and divide quickly to mount an immune response,” Chen says. “So they are very vulnerable to drugs that kill rapidly dividing cells.”

Just remember, it’s to be expected with chemo. “Neutropenia tends to follow a pretty typical pattern, and your doctor will know how to deal with it,” Chen says.

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