Fever and survival with drug-treated non-small cell lung cancer

Patients with non-small cell lung cancer who develop fever during anti-neoplastic chemotherapy are treated empirically, before the cause of fever has been determined. Little study has been made of episodes of infection during chemotherapy with respect to antineoplastic response, other adverse reactions, or survival time. In particular, the relationship between fever and long-term survival is not clear. The prognostic significance of febrile episodes was investigated in patients with non-small cell lung cancer receiving full-dose chemotherapy. Most were treated only with chemotherapy during the period of investigation, although some had concurrent or subsequent radiotherapy, and a few had surgery following chemotherapy. No significant difference was seen between febrile and afebrile patients regarding therapeutic modality. Patients with poor performance status (PS) had a higher incidence of febrile episodes (P < .001). Multivariate analysis, however, showed febrile episodes to be a major prognostic factor independent of PS on clinical stage. PS and stage affected short-term survival, while febrile episodes were related to decreased long-term survival (203 vs. 366 days; with deaths in the first 3 months excluded, 241 vs. 377 days). Although existing evidence is inconclusive, our study suggests that prevention of infection during antineoplastic treatment by administration of granulocyte stimulating factors and early initiation of antimicrobials might improve long-term survival.