If you are undergoing chemotherapy for breast cancer , you may be feeling very tired, lethargic, and sick all the time. This is actually a common occurrence for many people during chemotherapy. This is because the treatment reduces the number of white blood cells, a type of immune system that is important for our body. This is what we are talking about today.
What is neutropenia?
Simply put, when disease-causing germs, such as bacteria and viruses, enter our bodies, we have an army to fight them. The frontline fighters in this army are white blood cells called neutrophils .
Now think about it, chemotherapy is a powerful drug that kills cancer cells. These drugs cannot recognize cancer cells as well as healthy cells in our body that divide rapidly. So, when they kill cancer cells, these soldiers called neutrophils that divide rapidly are also killed.
Just as our military is more vulnerable to attack when the number of soldiers decreases, our bodies are more susceptible to infections when the number of neutrophils decreases. Medically, we call this decrease in neutrophils neutropenia .
But it's important to remember that neutropenia is just a temporary side effect of chemotherapy. Your body will return to normal once the treatment is over.
What should we do to protect ourselves from infections?
We need to be extra careful during this time, as even a minor cold can become serious. Here are some simple steps you can follow.
| Steps to take | Description and importance |
|---|---|
| Getting vaccinated | Get all the vaccines your doctor recommends (like flu shot, COVID-19, pneumonia). These vaccines provide you with great protection when your immune system is weak. |
| Wash your hands frequently. | This is the best and simplest way to protect yourself from germs. Wash your hands thoroughly with soap and water for at least 20 seconds. Be sure to wash your hands after coming from the outside, before eating, and after using the bathroom. |
| Staying away from sick people | Stay away from people who have coughs and colds as much as possible. Even if they say, "It's fine now, it's not contagious," don't take any risks. |
| Avoiding crowded places | Minimize your visits to crowded places like buses, shops, temples, and churches. If you must go, wear a good mask and leave quickly. |
| Food safety | Cook food thoroughly. Avoid eating raw or undercooked meat and fish (e.g. sushi, undercooked steak). Wash and clean vegetables and fruits thoroughly before eating. |
| Help from family members | Tell your family about this and ask them to follow these safety measures as much as possible. That will be a huge help to you. |
What time should I see the doctor?
You don't need to check for a fever every day while undergoing chemotherapy . However, if you experience any signs of infection, tell your doctor right away.
Keep an eye out for these signs:
- Fever (usually above 100.4°F or 38°C)
- Feeling hot or shivering
- Difficulty breathing
- Feeling extremely tired and lifeless
- Feeling unwell, different from usual
If you develop a fever, don't ignore it. Call your doctor right away. He or she will tell you whether to stay home, come to the clinic, or go to the nearest hospital.Whether to go to the Emergency Treatment Unit (ETU). If you go to the ETU, be sure to tell the doctor there that you are receiving chemotherapy.
How long does neutropenia last?
How severe this condition is and how long it lasts will vary depending on the type of chemotherapy you receive.
Typically, neutrophil levels drop the most in the middle of a chemotherapy cycle. For example, if you are receiving chemotherapy every 4 weeks, your neutrophil levels will reach their lowest level about 2 weeks after the treatment. This may get worse as your treatment continues. But don't worry, your doctors are prepared for it.
What are the treatments for this?
There is a special class of drugs that doctors use to reduce the duration of neutropenia and protect you from infections. These are called G-CSF (granulocyte colony-stimulating factors) . Simply put, these drugs stimulate your bone marrow and increase the production of white blood cells (especially neutrophils).
These are usually given as an injection about 24 hours after the chemotherapy dose.
Long-acting G-CSF
This type, which requires only one injection per round of chemotherapy, is the most commonly used type now. There are two ways to get it:
1. Going back to the hospital the day after chemo to get the injection.
2. Alternatively, you can self-inject at home or have a family member inject it.
In addition, there is a new device called Onpro . In this, a small pack containing the injection is attached to the skin of your arm. After about 27 hours, the medicine is automatically injected under the skin through a small needle inside. This is a good option for those who are afraid of injections and do not want to go back to the hospital.
Short-acting G-CSF
In this type, you have to take several injections daily between two rounds of chemo. Although these are less common with the advent of long-acting drugs, doctors may still recommend them if some people experience more side effects from long-acting drugs.
Side effects of these medications
The most common side effects of G-CSF are bone and muscle pain and fever . These can usually be controlled with painkillers (ask your doctor).
Take-Home Message
- Neutropenia is a common and temporary condition that occurs during chemotherapy. Don't worry about it unnecessarily.
- Your biggest risk during this time is infection , so be sure to follow safety measures like washing your hands and avoiding crowds.
- If you develop a fever or have signs of infection , call your doctor right away.
- There are effective treatments, such as G-CSF, to quickly restore your white blood cell levels.
- You are not alone on this journey. Your medical team is always ready to help you. So talk to them about any concerns.
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