Persistent Fever and Breathing Issues in Brain Cancer Patients

Q: Persistent Fever and Breathing Issues in Brain Cancer Patients

If a 25-year-old woman says： 1. <br>This is your only family member! However, the reality is that the disease has metastasized and has progressed to stage IV. <br>If her physical condition is poor, it can be considered terminal. <br>Generally, even after chemotherapy and radiatio

Breast cancer metastasis to the brain, with persistent fever and shortness of breath?

I'm sorry to hear about your family's situation.
Here are the translated questions:
Q1: The doctor said the wheezing is due to pneumonia, but why does it continue to worsen even after the pneumonia has improved? Could it be related to the brain cancer?
Q2: Persistent fever indicates that there is an issue in the body.
Shouldn't the patient remain hospitalized until the fever resolves, rather than just taking antipyretics? I read online that cancer can cause fever, and treatment should be expedited.
The chemotherapy that was supposed to be done this week was not carried out, and the doctor said they couldn't find anything.
Q3: If the fever does subside, how long should it remain down to be considered safe?
Q4: The patient is using an oxygen nasal cannula in the hospital.
Will prolonged use be harmful or lead to dependency? Besides deep breathing, what else can the patient do to help themselves?
Q5: Why was the three-centimeter brain tumor not detected during the targeted therapy a few weeks ago, but was found during an emergency visit? Now that we cannot determine the cause of the symptoms and have to wait three months for further tests, how can we know if the brain tumor is growing or if it is under control?
I understand that all the online speculation may not be accurate, but I feel very helpless.
This is my only family member, and they do not exhibit other symptoms of pneumonia, only wheezing and fever.
Thank you for taking the time to read my lengthy questions; I truly appreciate it.

Ruo, 20~29 year old female. Ask Date: 2019/12/02

Dr. Chen Sirong reply Oncology

If a 25-year-old woman says: 1.
This is your only family member! However, the reality is that the disease has metastasized and has progressed to stage IV.
If her physical condition is poor, it can be considered terminal.
Generally, even after chemotherapy and radiation therapy for brain metastases, the average life expectancy is only six months.
2.
I am unsure if palliative care has been consulted during her hospitalization.
Your family seems to need the assistance of a palliative care team.
3.
In the terminal phase of this life journey, you may feel that the more the patient is treated, the weaker she becomes.
Family members who initially had good spirits and appetite are now unable to eat and are excessively drowsy...
The tumor has spread throughout the body and released certain chemicals that cause the patient to lose appetite, experience fever (tumor fever), and regardless of food intake, weight continues to decrease, leading to muscle wasting, etc.
Perhaps it is not the physician's treatment that can reverse the patient's fate.
4.
I am really worried, but there is nothing I can do; the only thing you can do is to accompany her! The difficult feeling in this companionship is watching her suffer while feeling helpless.
But the key is companionship! It is not about doing anything; naturally reaching the end is also good! To answer your questions: Q1.
The doctor said the wheezing is due to pneumonia, but why does it continue and worsen even after the pneumonia has resolved? Could it be related to brain cancer? A: Terminal patients often experience multiple organ failure; the lungs may not have fully healed after pneumonia.
It should not be brain cancer but breast cancer that has metastasized to the brain, which will continue to spread to other areas in the future.
Q2.
Continuous fever indicates there is a problem in the body; it shouldn't be that just taking antipyretics means she can be discharged, right? I checked online, and it could be due to cancer-related fever...
Cancer treatment should be expedited; she missed her chemotherapy this week, and the doctor said nothing could be detected.
A: Cancer-related fever can occur during chemotherapy; however, if there is pneumonia or infection in other areas, chemotherapy cannot be administered until the physician confirms the situation.
Q3.
If she does have a fever, how long should it subside to be considered a safer range? A: 5-7 days.
Q4.
Will wearing an oxygen nasal cannula in the hospital be harmful or create dependency? Besides deep breathing, how else can the patient help herself? A: There will be no dependency; it is due to the fluctuating condition that sometimes she needs it and sometimes she does not, or if it continues to worsen, she will always need it.
When progressing to multiple organ failure, deep breathing alone will not help the patient, nor will the medical team be able to assist her.
Q5.
Why was a targeted therapy done at 21 but could not detect a 3 cm brain tumor, yet it was found in the emergency room the same day and confirmed the next day? Now that we cannot find the cause and must wait three months for further testing, how do we know if the brain tumor has grown or is under control? A: Treatment cannot detect brain metastases; treatment is treatment, and testing is testing; these two should not be confused.
Testing should only be done when symptoms arise.
The treatment failed, leading to metastasis to the brain.
Further investigation into the undetermined cause can continue, but the fever is not caused by the enlargement of brain metastases.
The growth or shrinkage of the brain tumor is not significantly related to her survival time.
I suggest you consider your family member's situation from the perspective of a terminal patient.
Thank you for your letter.
Just sharing with you: Believing in the Lord does not grant eternal life; one must die and be resurrected in heaven to attain eternal life.
Taoyuan Hospital, Chen Si-Rong.

Reply Date: 2019/12/02

More Info

I'm truly sorry to hear about the difficult situation your family is facing. Dealing with a loved one's cancer diagnosis and the complications that arise can be incredibly challenging and emotionally taxing. Let's address your questions regarding persistent fever and breathing issues in the context of brain cancer and its treatment.

Q1: Why is there persistent shortness of breath even after pneumonia has been treated? Could it be related to brain cancer?
Shortness of breath can have multiple causes, especially in a patient with a history of cancer. While pneumonia is a common cause, it is possible that the underlying cancer, particularly if it has metastasized to the lungs or is affecting the central nervous system, could contribute to respiratory issues. Brain tumors can lead to increased intracranial pressure, which may affect the brain's ability to regulate breathing. Additionally, treatments like radiation can cause inflammation in the lungs, leading to symptoms that mimic pneumonia. It's crucial to have a thorough evaluation by the healthcare team to rule out other potential causes of respiratory distress.

Q2: Does persistent fever indicate a problem, and is it enough to justify not discharging the patient?
Yes, persistent fever is a significant clinical sign that something is amiss in the body. In cancer patients, fever can be due to various reasons, including infections, inflammatory responses, or even tumor-related fever. The fact that the fever persists despite antipyretics (fever-reducing medications) suggests that the underlying issue has not been resolved. It is essential for the medical team to investigate further to determine the cause of the fever before considering discharge.

Q3: How long should a fever persist before it is considered safe?
Typically, a fever that lasts for more than 5-7 days, especially in a cancer patient, warrants further investigation. If the fever resolves temporarily but recurs, it indicates that the underlying issue has not been adequately addressed. Continuous monitoring and evaluation are crucial in such cases.

Q4: Is long-term use of supplemental oxygen harmful, and what else can the patient do to help themselves?
Using supplemental oxygen is generally safe and necessary for patients with respiratory distress. It does not typically lead to dependency, but it is essential to monitor the patient's oxygen levels regularly. In addition to deep breathing exercises, patients can benefit from physical therapy to improve lung function and overall strength. Encouraging hydration and a balanced diet, as tolerated, can also support recovery.

Q5: Why was the brain tumor not detected earlier, and how can we monitor its status now?
The detection of brain tumors can sometimes be challenging, especially if they are small or asymptomatic. Imaging studies like CT or MRI are critical for monitoring tumor growth. If there is a concern about tumor progression, the healthcare team may recommend more frequent imaging or other diagnostic tests. It's essential to maintain open communication with the medical team regarding any new symptoms or changes in the patient's condition.

In conclusion, your concerns are valid, and it’s important to advocate for your loved one’s health. Encourage open communication with the healthcare team, and don’t hesitate to ask questions about treatment plans and symptom management. Palliative care and support services can also provide additional resources to help manage symptoms and improve quality of life. Remember, you are not alone in this journey, and seeking support for yourself is equally important.

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