著者: E Toussaint, E Bahel-Ball, M Vekemans, A Georgala, L Al-Hakak, M Paesmans, M Aoun
雑誌名: Support Care Cancer. 2006 Jul;14(7):763-9. doi: 10.1007/s00520-005-0898-0. Epub 2006 Mar 10.
Abstract/Text
GOALS OF WORK: The aim of this study was to determine the causes of fever among cancer patients.
METHODS: All febrile cancer patients were followed up prospectively. Clinical, microbiological and radiological documentations were performed. Aetiologies of fever, type of tumour, site of infection, type of microorganism and outcome were assessed and compared between neutropenics and non-neutropenics.
RESULTS: Four hundred and seventy-seven episodes were evaluated. Infection, non-infectious causes and fever of unknown origin represented 67, 23 and 10%, respectively. The respiratory tract is the most frequently involved site in infection (29%), and in microbiologically documented infections, Gram-negative bacilli were predominant. The tumour itself (27%) or an invasive procedure (17%) were the main causes of non-infectious febrile episodes. Mortality from infection was higher among non-neutropenic (11.1%) than neutropenic patients (4.3%).
CONCLUSION: Fever in cancer patients remains a challenge, and the differentiation between infectious and non-infectious causes at onset of fever is very difficult. Despite all the prophylactic measures, infection is still the principal cause. However, the infection-related mortality is low either in neutropenic or non-neutropenic patients.
PMID
16528534 Support Care Cancer. 2006 Jul;14(7):763-9. doi: 10.1007･･･
著者: J C Chang, H M Gross
雑誌名: Am J Med. 1984 Apr;76(4):597-603.
Abstract/Text
The clinical utility of naproxen as an antipyretic agent was examined in the differential diagnosis of fever of undetermined origin in patients with cancer. Twenty-two patients with cancer and fever of undetermined origin for more than seven days were treated with naproxen to control fever when there was no evidence of infection after a careful initial evaluation, and in most cases, after failure of antibiotic therapy. In final analysis, none of five patients with infectious fever had responses to naproxen. In contrast, 14 of 15 patients with neoplastic fever showed a prompt, complete, and sustained lysis of fever within 24 hours after the initiation of naproxen treatment, and the patients also showed symptomatic improvement. One patient with neoplastic fever who did not have a response to naproxen had lysis of fever after the removal of necrotic tumor tissue. Two patients with fever from connective tissue disease had a partial lysis of fever in response to naproxen. These data suggest that naproxen specifically produces the lysis of neoplastic fever and, therefore, is a useful agent in assisting in the differential diagnosis of infectious fever and neoplastic fever in patients with cancer and fever of undetermined origin.
PMID
6711574 Am J Med. 1984 Apr;76(4):597-603.
著者: Steven Vanderschueren, Daniël C Knockaert, Willy E Peetermans, Herman J Bobbaers
雑誌名: Am J Med. 2003 Nov;115(7):572-5.
Abstract/Text
PMID
14599638 Am J Med. 2003 Nov;115(7):572-5.
著者: J C Chang
雑誌名: Arch Intern Med. 1989 Aug;149(8):1728-30.
Abstract/Text
PMID
2764649 Arch Intern Med. 1989 Aug;149(8):1728-30.
著者: Jason A Zell, Jae C Chang
雑誌名: Support Care Cancer. 2005 Nov;13(11):870-7. doi: 10.1007/s00520-005-0825-4. Epub 2005 Apr 29.
Abstract/Text
Neoplastic fever, a paraneoplastic syndrome caused by cancer itself, represents a diagnostic challenge for the clinician and is an important issue in supportive oncology. Timely recognition of this febrile condition by differentiating it from other cancer-associated fevers, such as infection and drug reaction, is essential for effective patient management. Although the pathophysiology of neoplastic fever is not well understood, it is suspected to be cytokine mediated. In clinical practice, when a patient with cancer presents with unexplained fever, extensive diagnostic studies are needed to differentiate neoplastic fever from nonneoplastic fever. Only after excluding identifiable etiologies of fever can the diagnosis of neoplastic fever be suspected. According to our experience, the naproxen test is a safe and useful test in differentiating neoplastic fever from infectious fever in patients with cancer. In addition, naproxen and other nonsteroidal anti-inflammatory drugs have been effective in the management of neoplastic fever and offer a significant palliative benefit for the patient.
PMID
15864658 Support Care Cancer. 2005 Nov;13(11):870-7. doi: 10.100･･･
著者: J C Chang, H M Gross
雑誌名: J Clin Oncol. 1985 Apr;3(4):552-8. doi: 10.1200/JCO.1985.3.4.552.
Abstract/Text
Twenty-one patients with neoplastic fever due to malignancy were treated with naproxen. A prompt and complete lysis of fever was obtained in 20 patients within 12 hours when an adequate dose of naproxen was given, and a sustained normal temperature was maintained in all responding patients while receiving naproxen except for one in whom a low grade fever recurred. Lysis of fever usually was followed by excessive sweating and subjective symptomatic improvement. However, when naproxen was discontinued in ten patients, febrile state to the pretreatment level recurred in seven patients within three days. This observation suggests naproxen has a definite and effective antipyretic activity against neoplastic fever although it may recur as the drug is discontinued. Naproxen may be a useful adjunctive agent in patients with neoplastic fever for a short-term symptomatic relief.
PMID
3981226 J Clin Oncol. 1985 Apr;3(4):552-8. doi: 10.1200/JCO.198･･･
著者: J C Chang
雑誌名: J Pain Symptom Manage. 1988 Summer;3(3):141-4.
Abstract/Text
PMID
3262142 J Pain Symptom Manage. 1988 Summer;3(3):141-4.
