Cancer treatment with chemotherapy, radiation therapy, surgery, and biologic therapy puts patients at risk for development of infection. Compromised immune function associated with treatment can affect morbidity and mortality.
Prevention of infection in patients with cancer focuses on interventions to prevent infection because of neutropenia or other immune deficiency related to malignancy or its treatment. The risk of infection is associated with the degree and duration of neutropenia. More than 50% of patients with neutropenia can be expected to develop infection. Evidence included here is focused on preventing interventions, rather than treatment of infection or febrile neutropenia.
Patients receiving standard chemotherapy regimens for solid tumors are at lower risk for development of febrile neutropenia and infection than patients who undergo bone marrow or stem cell transplantation. Interventions in these two different groups of patients for the prevention of infection can be expected to differ substantially in terms of level of effectiveness. PEP resources and evidence categorization is grouped for general patients with cancer and patients undergoing high-dose chemotherapy and bone marrow or any type of stem cell transplantation separately. This general section is applicable to any patients that are not undergoing transplantation.
Immune-Related Adverse Events With Immunotherapy
The treatment of severe immune-related adverse events (irAE) and symptoms may require significant immunosuppression with high-dose steroids, infliximab, or other immunosuppressive agents. Nurses need to be aware of the increased potential for infection because of immunosuppression, monitor patients for signs of infection, and recognize the potential for opportunistic infections. Patient education should emphasize the need to monitor for and report any signs of infection (Kyi, Hellmann, Wolchok, Chapman, & Postow, 2014).
This topic was updated on April 20, 2017.
Brahmer, J.R., Lacchetti, C., Schneider, B.J., Atkins, M.B., Brassil, K.J., Caterino, J.M., ... Hallmeyer, S. (2018). Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline. Journal of Clinical Oncology, 36, 1714–1768. https://doi.org/10.1200/JCO.2017.77.6385
Kyi, C., Hellmann, M.D., Wolchok, J.D., Chapman, P.B, & Postow, M.A. (2014). Opportunistic infections in patients treated with immunotherapy for cancer. Journal for Immunotherapy of Cancer, 2, 19. https://doi.org/10.1186/2051-1426-2-19