Medical Oncologist
Caretaker guide
Taking a temperature during chemotherapy
With a digital thermometer, the same way every time, at least twice a day on the low-count days and whenever the person feels unwell. Write every reading down. A fever with low white cells is an emergency that moves quickly and is very treatable when caught early, and the thermometer usually notices before the patient does.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
How do you take a temperature properly during chemotherapy?
With a digital thermometer under the tongue or in the armpit, the same way every time, at least twice a day on the low-count days and any time the person feels unwell, shivery or simply not right. Write every reading down with the time. That habit is the single most consequential thing a caretaker does during a course of chemotherapy.
The reason is that a fever with low white cells is an emergency that moves quickly and is very treatable when caught early. The patient often cannot tell they have a temperature, and by the time they feel obviously ill hours have been lost. The thermometer notices first.
Ask your team for your own fever threshold, in writing
The temperature at which you go to hospital, rather than wait, should come from your own oncologist. Write it on the fridge beside both hospital numbers.
Never give paracetamol before taking the temperature
And never give it to bring a fever down before the person has been seen. It hides the one sign the emergency team needs, and it is the commonest mistake families make at night.
Shivering counts even with a normal reading
Uncontrollable shivering, feeling suddenly very unwell, or confusion are reasons to go to hospital even if the thermometer has not yet risen. Trust the person rather than the number.
Keep a spare thermometer and spare batteries. A dead thermometer at two in the morning is a real problem.Doing it right
The details that make a reading reliable
- Use a digital thermometer
- Not a mercury one, which is hard to read and dangerous if broken, and not a forehead strip or the back of a hand. A simple digital thermometer from a pharmacy is accurate enough and easy to use.
- Use the same site every time
- Under the tongue or in the armpit, consistently, because the two give slightly different readings. Changing between them makes the numbers impossible to compare across a day.
- Wait after hot or cold drinks
- For an oral reading, wait a little after a hot drink, a cold drink or a bath, because all of them distort the result. An armpit reading needs dry skin and the arm held close.
- Leave it in until it beeps
- Taking it out early gives a falsely low reading. Wait for the signal, read it at once, and write it down before doing anything else.
- Clean it between uses
- Wipe the tip before and after, and keep the patient's thermometer for the patient only. Sharing it with a child who has a cold is how infections travel around a house.
- Write down every reading with the time
- A notebook or the phone, whichever you will actually keep up. When you ring the hospital, a list of readings across the day is far more useful than one number.
Not sure whether this applies to you?
Ask an oncologistWhen to check
A routine that catches a fever early
Every morning and evening on the low-count days
Ask your team which days of the cycle those are, and take the temperature at the same times each day through them. Put it with a meal or a medicine so it is not forgotten.
Any time the person feels unwell
Shivery, hot, suddenly tired, confused, off their food, or simply not right. Do not wait for the next scheduled reading; take it now.
Before giving any fever or pain medicine
Always take the reading first. If there is a temperature, ring the hospital or go in rather than giving paracetamol to bring it down.
If it is borderline, check again shortly
A reading just under your threshold should be repeated a little later rather than dismissed. Write down both readings and the times.
At or above your threshold, act immediately
Ring the hospital number or go straight to the nearest emergency department, day or night. Take the readings, the treatment summary and the medicine list with you.
!
Go to the nearest emergency department at once, day or night
A temperature at or above the threshold your team gave you · shivering uncontrollably, even if the reading is normal · feeling suddenly very unwell · confusion or being hard to rouse · breathlessness · a racing heart · no urine since the morning · redness, pain or discharge around a port or line. Say clearly that the person is on chemotherapy. Do not give paracetamol to bring the temperature down first, do not wait for morning, and do not wait to see whether it settles.
Being straight with you
What this page cannot tell you
It deliberately does not give you a number. The threshold at which a patient on chemotherapy should go to hospital is set by the treating team, and it can differ between patients and between drugs. Ask for yours and have it written down; do not borrow somebody else's.
It also cannot tell you whether a particular fever is serious. That is decided by examination and a blood test, which is exactly why the rule is to go in rather than to judge it at home.
Going in and being sent home is a good outcome
Families hesitate at night because they do not want to waste anybody's time. Nobody on an oncology or emergency team thinks a fever check on chemotherapy is a waste of time. The mistake is waiting.
Know which hospital to go to before you need it
At two in the morning nobody can work out which emergency department is open, how to get there, or who will drive. Decide that now and write it on the fridge.
Teach a second person
The main attendant will not be there every night. Show one other household member how to take a reading, where the numbers are written, and what the threshold is.
What to do next
Buy a digital thermometer and a spare today. Ask your team for your fever threshold in writing and put it on the fridge with both hospital numbers and the name of the hospital to use at night. Start a notebook of readings, and teach one other person.
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Commonly believed
Four mistakes families make at night
"Give paracetamol and see if it comes down."
This is the commonest and most consequential mistake. It hides the one sign the emergency team needs and loses hours. Take the reading, and if there is a temperature, go in without giving anything first.
"He feels warm, so I can tell without a thermometer."
A hand on the forehead is unreliable, and patients on treatment frequently do not feel feverish when they are. A digital thermometer used the same way every time is what catches it early.
"It is only slightly raised, so we will wait until morning."
Infection with low white cells moves fast and is very treatable when caught early. At or above your threshold, go the same night. Borderline readings should be repeated shortly rather than dismissed.
"The thermometer is normal, so the shivering does not matter."
Uncontrollable shivering, sudden severe unwellness or confusion are reasons to go in even before the reading rises. Trust the person rather than the number.
Questions we are asked
Common questions about temperature checks
What temperature means we should go to hospital?
Ask your own oncologist for the threshold and have it written down, because it is set by the treating team. At or above it, go to the nearest emergency department at once, day or night.
What kind of thermometer should we buy?
A simple digital thermometer from a pharmacy, plus a spare and spare batteries. Avoid mercury thermometers, forehead strips and judging by touch.
Under the tongue or in the armpit?
Either, as long as you use the same site every time, because they read slightly differently. Wait a little after hot or cold drinks for an oral reading, and keep the skin dry for an armpit one.
How often should we check?
Morning and evening through the low-count days, and any time the person feels unwell, shivery or not right. Ask your team which days of the cycle count as low-count.
Can we give paracetamol for a fever?
Not before the person has been seen. Giving it hides the sign the emergency team needs. Take the reading and go in; the hospital will decide what to give.
What should we take to the emergency department?
The list of readings with times, the treatment summary, the medicine list and the hospital numbers. Say clearly at the desk that the person is on chemotherapy.
We went in and were sent home. Did we overreact?
No. A fever check on chemotherapy is never a waste of anybody's time, and being sent home is a good outcome. The mistake is waiting, not going.
What if the reading is normal but they are shivering?
Go in. Uncontrollable shivering, feeling suddenly very unwell or confusion are reasons to be seen even before the thermometer rises.
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Sources
- Macmillan Cancer Support — Chemotherapy and infection risk
- National Cancer Institute — Chemotherapy and You: Support for People With Cancer
- Macmillan Cancer Support — Looking after someone with cancer
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