Ovarian cancer is one of the common malignant tumors of the female reproductive system, and its treatment options are diverse, among which chemotherapy is an important treatment.
However, chemotherapy not only kills cancer cells, but also affects normal cells, weakening the patient's immune system, thereby increasing the risk of infection.
1. Risk of infection during chemotherapy
The suppressive effect of chemotherapy on the immune system is the main reason why it increases the risk of infection. The following are common risk factors for infection during chemotherapy:
1. Bone marrow suppression
The suppressive effect of chemotherapy drugs on the bone marrow causes a decrease in the number of blood cells, including white blood cells, red blood cells, and platelets.
This inhibition mainly affects the decrease in the number of white blood cells, especially neutrophils, which significantly increases the risk of infection.
White blood cells are the body's main line of defense against infection, and when their numbers are significantly reduced, patients are more susceptible to bacteria, viruses, and fungi.
Neutropenia (neutropenia) makes it impossible for the body to respond effectively and destroy pathogens, increasing the risk of serious infections and sepsis.
2. Decreased immune function
Chemotherapy not only reduces the number of white blood cells, but also weakens the overall function of the immune system.
Chemotherapy drugs inhibit the function of T cells, which play a key role in recognizing and destroying virus-infected cells, and B cells, which are responsible for producing antibodies to neutralize pathogens, making patients more susceptible to infection during and after chemotherapy and recovering from infection slower [1].
3. The mucosal barrier is damaged
The rapid division of cells in the gastrointestinal tract and oral mucosa makes them particularly susceptible to chemotherapeutic agents, leading to mucosal inflammation and ulcer formation.
Chemotherapy damage to the mucous membranes of the gastrointestinal tract, oral cavity, and respiratory tract can disrupt their barrier function and increase the chance of pathogen invasion through grinding.
For example, oral mucositis (mouth ulcers) and inflammation of the mucous membranes of the gastrointestinal tract not only cause patients to face pain and discomfort, but also provide a channel for bacterial and fungal infections, and even more serious systemic infections.
4. Intravenous catheter-related infection
During chemotherapy, patients often require long-term indwelling central venous catheters to facilitate drug infusion and blood tests. However, intravenous catheterization itself increases the risk of bloodstream infections.
This risk is particularly high when the catheter is not properly cared for or the catheter is placed for too long. Microorganisms tend to form biofilms on the surface of the catheters, causing local infections that may spread throughout the body through the bloodstream, causing severe bloodstream infections (bacteremia).
Therefore, strict catheter care and regular monitoring are important measures to prevent infections associated with intravenous catheterization.
5. Malnutrition and physical weakness
During chemotherapy, patients often do not consume enough nutrients due to side effects such as nausea, vomiting, and loss of appetite, resulting in malnutrition and physical weakness.
Malnutrition not only affects the overall health of patients, but also further weakens the immune system and makes patients more susceptible to infections. Malnutrition can also delay wound healing and recovery, increasing the risk of infection.
Maintaining good nutritional intake and physical fitness is essential to improve resistance and reduce the risk of infection.
6. History of previous infections
Patients with a history of previous infections are more likely to recurrent during chemotherapy, especially those with pre-existing chronic diseases or immunocompromised, such as diabetic patients, HIV infected patients, etc.
These patients have already weakened their immune systems, and chemotherapy has further weakened their immune function, making them more vulnerable to new infections or recurrences of previous infections.
Regular monitoring and prophylactic treatment are particularly important for these high-risk patients to minimize the risk of infection.
2. Prevention and management of chemotherapy-related infections
To reduce the risk of infection during chemotherapy, patients and care teams need to take a number of preventive and management measures:
1. Monitor the blood picture
Regular monitoring of blood counts, especially white blood cell and neutrophil counts, is essential for early detection and prevention of infection.
Through hemogram monitoring, doctors can keep abreast of a patient's immune status, especially during chemotherapy. When the white blood cell count is significantly lower, the risk of infection is greatly increased, and doctors may take several interventions, including the use of granulocyte colony-stimulating factor (G-CSF) to promote white blood cell production.
G-CSF is a drug that stimulates the bone marrow to produce more white blood cells, which helps shorten the duration of neutropenia and thus reduces the risk of infection.
In addition, patients may need to adjust their chemotherapy regimen or temporarily discontinue chemotherapy after they are found to be abnormal on hemogram monitoring to wait for the number of blood cells to return to safe levels [2].
2. Prophylactic antibiotics
When the white blood cell count is very low or the patient is at high risk of infection, doctors may prescribe antibiotics, antifungals, and antiviral drugs prophylactically.
The prophylactic use of these drugs is aimed at avoiding the occurrence of serious infections, especially in the case of neutropenia.
When the neutrophil count drops to dangerous levels, even a mild infection can quickly develop into a serious systemic infection.
Therefore, the use of prophylactic antibiotics can effectively reduce the probability of infection. In addition, depending on the patient's specific situation and medical history, the doctor may choose specific antimicrobial spectrum medications to target the pathogens that the patient is most likely to be infected with.
3. Strengthen personal hygiene
Patients should practice good personal hygiene to reduce the risk of infection. This includes washing your hands frequently, keeping your mouth clean, and avoiding contact with known pathogens or sources of infection.
Use soap and water when washing your hands, or use an alcohol-based hand sanitizer when you can't wash your hands. For patients with mouth sores, using a non-irritating mouthwash can help reduce discomfort and reduce bacterial growth.
Avoiding spicy and coarse foods can reduce the risk of mouth sores getting worse.
In addition, patients should avoid contact with people with infectious diseases, especially during immunocompromised periods, and reducing social activities and using public transportation can also reduce the chance of infection.
4. Catheter care
Care of central venous catheters must be performed in strict accordance with aseptic protocols to prevent infection.
Caregivers should change the catheter dressing regularly, keep the catheter site clean and dry, and monitor the catheter insertion site daily for signs of infection such as redness, swelling, pain, and oozing.
If you notice signs of infection, you should report it to your doctor immediately and take appropriate measures. Another way to reduce the risk of infection is the use of antimicrobial-coated catheters, which are specially treated to inhibit the growth of bacteria on the catheter surface.
In addition, caregivers and patients should be trained to ensure that they understand and follow proper catheter care procedures.
5. Nutritional support
During chemotherapy, ensuring that patients receive adequate nutritional support is essential to maintain immune function and overall health.
With the guidance of a dietitian, a personalized diet plan can be developed to ensure that patients are getting enough protein, vitamins and minerals.
If patients have difficulty eating properly due to chemotherapy side effects such as nausea and vomiting, their doctor may recommend enteral or parenteral supplements.
These supplements can provide the nutrients needed to help patients maintain their weight and stamina, and strengthen their immunity. In addition, dietitians can also help patients choose easily digestible, nutrient-rich foods that reduce the occurrence of gastrointestinal upset.
6. Vaccination
Before chemotherapy begins, your doctor may recommend a flu and pneumonia vaccine to prevent common respiratory infections.
These vaccines can help patients fight off common viral and bacterial infections during immunocompromised periods. However, live vaccines should be avoided during chemotherapy because they can trigger infections when the immune system is suppressed.
Depending on the patient's specific condition and immune status, the doctor will develop an appropriate vaccination schedule to ensure the best possible protection before and after chemotherapy.
In addition, family members and close contacts should also consider these vaccines to reduce the risk of transmitting the pathogen to the patient.
Infection is one of the common and serious complications of chemotherapy for ovarian cancer, but with effective prevention and management measures, the risk of infection can be significantly reduced.
It is hoped that this article can help ovarian cancer patients and their families understand the risk factors for infection in chemotherapy, and take proactive measures to cope with and prevent infection, ensure smooth treatment and improve quality of life.
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[1] Liu Haifeng, Wang Jingyi, Han Subin, et al. Chinese Journal of Pathogenic Biology,2024,19(06):671-674+679.DOI:10.13350/j.cjpb.240610.
[2] Liu Lina, You Chunhua, Xu Rui, et al. Effect of prophylactic application of recombinant human granulocyte colony-stimulating factor after tumor cytoreductive surgery on myelosuppressive secondary infection in patients with advanced ovarian cancer[J].Cancer Progress,2023,21(23):2613-2616.)