How Long After Chemotherapy is my Immune System Compromised?

Northwestern Medicine
Cancer Care/Oncology March 17, 2020

Attribute to: Christopher George, MD, hematology and oncology at Northwestern Medicine Delnor Hospital

For a .pdf of this document, click here.

How does chemotherapy affect a person’s immune system?
It varies depending on the person and the type of chemotherapy, but for a typical patient who receives immunosuppressive chemotherapy, we see the immune system become more and more impaired over the next four to seven days. At that point it will “hit bottom” and then begin to recover, usually in time for the next cycle of chemotherapy.

How long after chemotherapy is a person’s immune system recovering or compromised?
Patients experience a wide spectrum of immunosuppression with cancer treatment. Some patients have very little if any immunosuppression, while others can have a compromised immune system for weeks or even longer. Patient should talk to their physician about the degree and duration of immunocompromise.

What can a person do to support their body’s healing after chemotherapy?
There are medicines we commonly use to help the immune system recover quickly from chemotherapy. These are often very appropriate and useful, but not always. “Immune-boosting” foods and supplements are promoted all over the Internet, however unfortunately there is very little evidence that these do any good.

What other recommendations do you have for people who are currently receiving chemotherapy or who recently received it?
I am a big believer in physical activity before and after chemotherapy. It helps patients recover faster from side effects. Even during treatment, exercise is beneficial if patients are able. For patients who need encouragement or assistance, physical therapy can be very helpful, especially after treatment is over.

Is a person more at risk for a severe case of COVID-19 if they recently had chemotherapy?
I am worried about my chemotherapy patients during the COVID-19 crisis, but as of today, March 18, 2020, I am making the same recommendations for them as I am for healthy individuals. Specifically, we should all practice physical distancing as we are able. Patients with a flu-like illness should call their physician, but stay away from health care clinics and emergency departments if possible. Of course, this is an evolving situation and recommendations are changing rapidly.

When should a person call their physician if they are receiving chemotherapy and they think they may have COVID-19?
I tell my patients, if you have a concern, call our office. If you have a question, call. If the situation turns out to be no big deal, that does not mean it was wrong to call.
On March 18, 2020, we began to ask patients to call if they have fever and respiratory symptoms (cough, sore throat, congestion, etc.). These patients are assessed over the phone and given further instructions. Sometimes we recommend they stay home, sometimes proceed to a designated location for testing, and in serious cases, proceed to the Emergency Room after we call to let them know the patient is coming. But I anticipate our process will be changed/refined in the coming days and weeks.

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