Excessive sweating occurs in 10 to 20% of patients with advanced cancer, occurs more at night and may require a change of clothes, bedding or both.
There are multiple causes including:
- infection (check patient is not at risk of neutropeanic sepsis)
- disseminated cancer (particularly with liver metastases)
- SSRI (selective serotonin reuptake inhibitor) antidepressants
- hormone therapies (tamoxifen, aromatase inhibitors, gonadorelin analogues)
- oestrogen deficiency (natural or treatment-related menopause)
- androgen deficiency (surgical or hormone treatment)
- autonomic neuropathy.
- Treat any underlying cause, including infection (if appropriate).
- Reduce room temperature, remove excess bedding, increase ventilation, use a fan.
- Wear loose cotton clothing.
- Cool with tepid sponging.
- Maintain fluid intake to avoid dehydration.
- Review medication and prescribe an alternative if possible.
- Consider opioid switch. (see choosing and changing opioids guideline)
Sweating with pyrexia:
- paracetamol 500mg to 1g (depending on body weight), 6 hourly
- non-steroidal anti-inflammatory drug (NSAID).
Sweating without pyrexia (associated with tumour):
- antimuscarinic (amitriptyline 10 to 50mg at night)
- cimetidine 400 to 800mg once daily. (Check British National Formulary (BNF) for drug interactions)
- venlafaxine under specialist advice, initiate at 37.5mg (modified release once daily) and increase to 75mg (modified release once daily) if tolerated.
Sweating with hormone insufficiency:
- seek advice from an oncologist about hormone replacement therapy.