Feeling cold or experiencing sudden chills is a very common side effect reported by individuals undergoing chemotherapy treatment. Chemotherapy is a systemic treatment that uses powerful drugs to destroy rapidly dividing cancer cells, but it also affects healthy, fast-growing cells throughout the body. The resulting disruptions to various biological processes create several distinct ways the body can react with sensations of coldness. Understanding the different causes behind the cold sensation is important for managing this common experience.
Acute Temperature Changes During Infusion
Chills and a sudden sensation of coldness can occur immediately during or shortly after the chemotherapy drug is administered intravenously. One reason for this acute reaction is the introduction of fluids that are cooler than body temperature directly into the bloodstream. More complex reactions, known as infusion-related reactions, can also cause these acute chills. These reactions may involve the release of inflammatory chemicals called cytokines, which can lead to a sudden, temporary spike in body temperature, often preceded by shaking chills. For individuals receiving specific platinum-based agents, like oxaliplatin, an intense, immediate cold sensitivity may begin during the infusion.
Anemia and Chronic Cold Sensation
A persistent, chronic feeling of coldness is often directly related to a condition called chemotherapy-induced anemia. Chemotherapy drugs frequently damage the bone marrow, which is the body’s factory for producing new blood cells. This damage can significantly decrease the production of red blood cells, leading to anemia. A reduced red blood cell count means less oxygen is available to fuel internal heat production, resulting in a systemic cold intolerance. Furthermore, the body may prioritize blood flow to the vital organs, which often reduces circulation to the extremities, making the hands and feet feel particularly cold.
Nerve Damage and Heightened Cold Sensitivity
Certain chemotherapy agents are known to damage peripheral nerves, leading to chemotherapy-induced peripheral neuropathy (CIPN). This nerve damage often results in a heightened, sometimes painful, sensitivity to cold temperatures, especially in the hands and feet. This is a sensory issue, not a systemic loss of body heat. For example, the platinum drug oxaliplatin commonly causes cold allodynia, where a non-painful cold stimulus is perceived as painful. The neuropathy requires avoiding cold triggers, such as wearing gloves when reaching into a refrigerator or avoiding ice-cold beverages.
Recognizing Chills as a Sign of Infection
The most dangerous type of chill during chemotherapy is a shaking chill, or rigor, that signals a potentially severe infection. Chemotherapy often lowers the count of infection-fighting white blood cells, specifically neutrophils, leading to neutropenia. A fever in this context is defined as a single oral temperature of 100.4°F (38.0°C) or higher, or a temperature sustained over an hour. Fever and chills may be the only signs of a rapidly progressing infection, which can quickly develop into sepsis. Any patient experiencing shaking chills or a fever should contact their oncology care team immediately for prompt evaluation and the start of broad-spectrum intravenous antibiotics.