Infection during breast cancer treatment

Some treatments for breast cancer increase the risk of infection, which can be serious.

The risk is highest for people having chemotherapy. Some targeted therapies can also increase your risk of infection.

If you do get an infection during treatment, it can usually be treated effectively with antibiotics.

Signs of infection

Know what to look out for. Learn how to take your own temperature at home and contact your nurse or doctor if you notice signs of infection.

As well as fever or chills, other symptoms include:

• cough
• sore throat
• headache or stiff neck
• pain, blood or a burning sensation when you pass urine
• sores or ulcers in your mouth
• redness, swelling or tenderness around a wound, sore, pimple or boil
• uncontrolled diarrhoea
• unusual vaginal discharge or itching
• if you have an IV, PICC or Port site:
  • pain, warmth, swelling or redness at the site
  • pus coming from the site
  • visible pus that looks like a pimple under the skin
  • any localised hardness
  • red streaks leading from the IV site.

Ways to reduce your risk of infection

Take steps to protect yourself from infection, especially during chemotherapy treatment.

• Practice good personal hygiene:
  • Wash your hands regularly with soap and water before eating, in public places, and after going to the toilet. If soap and water are not available, use alcohol-based hand sanitiser.
  • See a dentist before you start treatment.
  • Brush your teeth and shower every day.
  • Keep any cuts or scrapes clean.
• Stay away from people who may be unwell.
• Take care around the house:
  • Wear protective gloves if you are gardening, handling compost or picking up animal faeces.
  • Wear shoes and slippers as much as possible to protect your feet.

Infection related to chemotherapy

Chemotherapy drugs may reduce the number of white blood cells in your body. The main type of white cells that fight infection are called ‘neutrophils’.

A low level of neutrophils (‘neutropenia’) increases your risk of infection.

The highest risk is for people who have a combination of chemotherapy drugs from the taxane and anthracycline families.

Monitoring and treating low white blood cells

A drop in your white blood cell count usually happens 5 to 12 days after treatment and ideally recovers before your next treatment.

Your medical oncologist will order blood tests to check your white blood cell count while you are having treatment.

They need to ensure your count has recovered enough for you to have your next round of treatment. Sometimes they may delay chemotherapy for a few days to allow your white blood count to increase.

To encourage your body to produce white blood cells, your medical oncologist may recommend a drug called a growth factor (G-CSF) after each chemotherapy treatment. This is an injection given under the skin, usually 24 hours after chemotherapy.

Infection related to targeted therapies

Some targeted therapies such as palbociclib (Ibrance) and ribociclib (Kisqlai) increase your risk of infection.

It is important you discuss the risk with your medical specialist. You can ask them:

• does my treatment put me at risk of becoming very unwell if I have an infection?
• will the risk be higher at any particular time frame during my treatment?
• what should I do if I develop symptoms of infection?