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Side effect warning signs

Chemotherapy Red-Flag Card — Print It, Keep It Close

Most side effects during chemotherapy are expected and manageable at home. A small number are medical emergencies. This card tells you which is which — and what to do within the first hour.

Medically reviewed by Dr. Bharati Devi Gorantla, Medical Oncologist, MBBS · MD · DM (Adyar, Chennai) · ECMO · MRCP SCE (UK) · Last reviewed September 2026

  • Fever is never routine — During chemotherapy, any fever may mean your immune system cannot fight back. Call the same day, every time.
  • Bleeding needs review — Unexpected bruising, a nosebleed that will not stop, or blood in urine or stool is not normal during any chemotherapy cycle.
  • Breathlessness can escalate — New shortness of breath at rest or with very little effort is a same-day call, not a wait-and-see.
  • Write the number on the card — Your oncology team's contact number is the most important item on this page. Add it before anything else.
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The warning signs that need immediate action during chemotherapy include fever, uncontrolled bleeding, breathlessness at rest, signs of infection, and sudden chest pain. Your team will tell you the exact temperature reading to watch for — write it on your card. Call your team the same day for anything on that list.

What makes a chemotherapy side effect an emergency?

Fever
Chemotherapy reduces your white blood cells, which fight infection. When those counts are low, even a mild fever can mean your body is failing to control a bacterial infection on its own. This is called febrile neutropenia. NCCN and ASCO guidance treats it as a medical emergency, not a symptom to watch overnight.
Unexpected bleeding or bruising
Chemotherapy also lowers platelets, the cells that make your blood clot. When platelets are low, bruises appear from small knocks and cuts bleed longer than normal. Bleeding from the gut or urinary tract can happen without any injury — which is why blood in urine or stool during chemotherapy is always worth reporting.
Signs of infection at a line or wound
Redness, swelling, warmth or discharge around a drip site, central line, PICC line or port gives bacteria a direct route into the bloodstream. In a patient on chemotherapy, a local infection can become a whole-body infection much faster than in a healthy person.
Breathlessness at rest
New shortness of breath that appears when you are sitting still — or that is getting clearly worse — can point to a blood clot in the lungs, severe anaemia or an allergic reaction. It is not a side effect to wait out at home.
Sudden chest pain
Chest pain during or after chemotherapy needs emergency assessment, not an appointment. Some chemotherapy drugs can affect the heart. A blood clot in the lungs also causes chest pain that can feel like a pulled muscle. Go to the emergency department.

Which symptoms need an immediate call or hospital visit?

  • Any fever — check your temperature if you feel hot, shivery or cold for no reason
  • Shaking chills or rigors — uncontrolled shivering, with or without a measured temperature
  • A nosebleed or cut that does not slow after ten minutes of steady pressure
  • Blood in your urine, stool or vomit
  • Unexplained bruising, especially large bruises from small knocks
  • New shortness of breath at rest or with minimal effort
  • Sudden chest pain or tightness
  • Redness, swelling or discharge at your drip site, PICC line, port or any wound
  • Severe pain anywhere that is new or much worse than yesterday
  • Confusion, unusual drowsiness or difficulty waking
  • Unable to keep fluids down for more than a few hours
  • A mouth sore so painful you cannot swallow saliva or water

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What temperature should you call about?

Your oncology team will give you a specific reading to watch for. Write that number on this card before your first chemotherapy cycle — do not rely on memory when you are unwell at midnight.

NCCN and ASCO guidance treats any new fever during chemotherapy as needing same-day assessment, not a wait-and-watch approach. The reason is febrile neutropenia: when white cell counts are low, the body may not show the usual signs of infection until it is already advanced.

Do not take paracetamol — sold as Calpol, Dolo or Crocin — to bring a temperature down before calling. It will lower your reading and may hide the sign your team needs to see. Check the temperature first, then call.

Who do you call, and when?

Write your oncology team's number at the bottom of this card. Put the same number in your phone and on a piece of paper in your bag — you want it accessible if the person who normally knows it is not there.

Call your team the same day for anything on the checklist above. Do not wait for your next scheduled appointment, and do not wait to see if it improves overnight.

Go directly to the emergency department — without calling first — if you have chest pain, cannot breathe normally, are confused, or have bleeding you cannot control. In those situations, minutes matter more than a conversation.

What happens when you call?

Your team will ask about your temperature, your symptoms, and when your last chemotherapy cycle was. They may ask you to come in for a blood count the same day.

Most people who call are not admitted. The call is how your team decides whether you are safe at home or whether you need to be seen — and calling early almost always keeps more options open.

There is no such thing as calling too often. Every oncology team expects these calls from patients on chemotherapy. If you are unsure, call.

Explore 74 more Common Side Effects and How They Are Managed topics

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Common questions

Frequently asked questions

Can I take paracetamol or ibuprofen before I call about a fever?

Check your temperature first, then call — before taking anything. Paracetamol, sold as Calpol, Dolo or Crocin, will lower your reading and may hide the sign your team needs to assess. Ibuprofen can also mask fever and has additional effects on platelets that are relevant during chemotherapy. Once your team has the actual reading, they can advise what to take.

My temperature is normal but I feel terrible. Should I still call?

Yes. A normal temperature reading does not rule out a problem, particularly if you took paracetamol recently or the thermometer was not used correctly. If you feel shivery, have rigors, look pale, feel confused, or simply feel much worse than expected for the stage of your cycle, call and describe exactly how you feel — not just the number on the thermometer. Your team can judge whether you need to come in.

When in my cycle am I most at risk?

The highest-risk window is usually around one to two weeks after each cycle, when your blood counts reach their lowest point — a period called the nadir. Your team can tell you the specific timing for your regimen, which varies by drug. Mark those days on a calendar and keep this card especially close during them. Risk does not disappear outside the nadir, but those days are when fever matters most urgently.

I have a PICC line or port. Are there extra signs to watch for?

Yes. Redness, swelling, warmth or discharge around the exit site or port pocket needs same-day review, even if you feel otherwise well. A line that is not flushing normally also needs reporting. If the site looks significantly more inflamed than it did yesterday, do not wait for your next dressing change appointment — call today. An infected line gives bacteria a direct route to your bloodstream.

We live far from the nearest CION centre. What should we do in an emergency?

Go to your nearest government hospital emergency department. Neutropenic fever is a condition all emergency departments can begin treating, and the first steps — a blood count, IV fluids if needed, and starting antibiotics — do not require a specialist oncology unit. Call your CION team from the emergency department so they can speak to the treating doctor and make sure your full oncology history is known.

Is it safe to wait until morning if a fever starts at night?

No. Neutropenic fever is one of the situations in oncology where waiting until morning is not safe. Bacterial infections in patients with low white cell counts can move from a mild fever to a life-threatening state within hours. Call your team's after-hours number the same night. If you cannot reach anyone within a few minutes, go to the nearest emergency department rather than waiting for a callback.

Full index

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Blood Counts, Infection, Fever & Emergencies73

Anaemia & Low Haemoglobin

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Chemotherapy by Cancer Type and Special Situations5

Special Populations & Comorbidities

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Chemotherapy in Hyderabad: Cost, Centres & Access93

HUB — Choosing a Chemotherapy Centre and Safe Administration

Common Side Effects and How They Are Managed78
Food, Diet, Hydration & Household Safety6
How Chemotherapy Is Given: Regimens, Cycles & Infusion Days85

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HUB — When Chemotherapy Stops Working

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Understanding Chemotherapy, Myths & Trials97

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