Advice from medical professionals on which symptoms call for immediate action, and what to do if an emergency occurs.

Carmen Gonzalez, an Associate Professor of Emergency Medicine at MD Anderson Cancer Center in Houston, still remembers a patient who came to the emergency room nearly 20 years ago. The patient was a man in his 40s with sarcoma, who was undergoing chemotherapy and had disregarded a fever of more than 101 degrees Fahrenheit.

The fever raged for one day, then two and then three. By the fourth day, he was so fatigued his wife brought him to the ER—but it was too late. He succumbed to sepsis, a severe blood infection that can result from a chemotherapy-induced low white blood cell count.

Dr. Gonzalez could have saved the patient from this oncologic emergency with antibiotics and intravenous fluids if he’d come for help earlier. This is an important, and unfortunate, example of why it’s crucial for patients to take every precaution and be prepared to handle emergency situations.

Separating Common Side Effects From Emergency Situations

Deborah Mayer, an advanced practice oncology nurse and researcher at the University of North Carolina in Chapel Hill, explains oncologic emergencies fall into two categories: those that are urgent and those that can be prevented or managed early.

Serious oncologic emergencies requiring immediate medical attention include:

• Delirium

• Difficulty breathing

• Difficulty swallowing

• High temperature (100.4 degrees Fahrenheit or higher)

• Seizures

• Sudden pain

• Symptoms of a heart attack

• Swelling in the face, neck, tongue, arms or legs

• Uncontrollable bleeding

• Uncontrollable nausea or diarrhea

• Uncontrollable pain

Other symptoms may not warrant an immediate trip to the ER or a call to 911 but should be brought to the attention of your healthcare providers. This includes mild symptoms that are new or are getting worse. “The real trick is to get the problem evaluated, and let an oncology specialist decide the best approach,” Mayer says. “If the patient doesn’t talk about the problems, it’s hard for the oncologist…” to address the side effects proactively.

Timothy Moynihan, an oncologist at the Mayo Clinic in Rochester, MN, agrees it’s difficult for doctors to foresee every scenario. For that reason, Dr. Moynihan gives his patients a general set of rules: if you have mild symptoms, you can probably wait and call your doctor the next day. However, if symptoms are severe or worsen, it may be time to take action.

Preparing for an Emergency

Not everyone who has cancer is at risk for an oncologic emergency, but all patients and their caregivers need to prepare for such a possibility. Preparing for an emergency ahead of time can save precious minutes if you end up in an emergency room not affiliated with your care team.  

You can prepare for possible emergencies by:

• Keeping a copy of your medical records with you at all times

• Being up-to-date on your diagnosis and current treatments

• Having a list of all medications you’re taking and the dosage

• Having the contact information for your healthcare providers readily available

Keep this information together in a single folder, so you can grab it quickly. If you have the ability to access email on your mobile phone, you can also email this information to yourself. 

Before surgery or the beginning of a new treatment, discuss the potential side effects with your doctor. During the discussion, ask the doctor what to watch out for and what they would consider to be severe enough to warrant an emergency room visit. Your doctor may also be able to prescribe medications that can be used to prevent or treat side effects to avoid emergency situations. 

What to Do If You Experience Severe Symptoms and Side Effects

If you experience symptoms that are not normal, or you feel worse than expected, it’s best to act with an abundance of caution than to ignore the problem. If the symptoms don’t appear to be life threatening, take the following steps:

• First, call your doctor’s office. Many offices have a 24/7 answering service in the event of an emergency. A nurse or your doctor can assess the symptoms you’re experiencing and provide advice on the best course of action.

• Next, follow the advice of the nurse or doctor, but continue to monitor the situation carefully. If symptoms worsen, go to the ER—or call 911.

• If your caregiver isn’t with you, alert them of the situation immediately. 

Having a plan and knowing what to do in the case of a severe side effect, symptom or emergency is one of the best forms of preparation and ways to care for yourself.