Sweating

Scottish Palliative Care Guidelines
Healthcare Improvement Scotland

Introduction

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.

 

Assessment

There are multiple causes including:

  • infection (check patient is not at risk of neutropenic sepsis)
  • lymphoma
  • disseminated cancer (particularly with liver metastases)
  • medication
    • selective serotonin reuptake inhibitor (SSRI) antidepressants
    • hormone therapies (tamoxifen, aromatase inhibitors, gonadorelin analogues)
    • opioids
  • endocrine
    • oestrogen deficiency (natural or treatment-related menopause)
    • androgen deficiency (surgical or hormone treatment)
    • hypoglycaemia
    • hyperthyroidism
  • autonomic neuropathy.

 

Management

  • 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 (refer to Choosing and changing opioids guideline).

 

Medication

Sweating with pyrexia:

  • †Pracetamol 500mg to 1g (depending on body weight), 6 hourly
  • †Non-steroidal anti-inflammatory drug (NSAID).

 

Sweating without pyrexia (associated with tumour):

  • †NSAID
  • †Antimuscarinic (amitriptyline 10mg to 50mg at night)
  • †Cimetidine 400mg to 800mg once daily – refer to 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.  

 

References

Doyle, D., Hanks, G., Cherny, N., and Calman, K., (Eds) 2004. Oxford textbook of palliative medicine. 3rd ed. Oxford: Oxford University Press.

NHS Highland 2010. Palliative Care Guidelines: Sweating in Palliative Care in Adults. NHS Highland.

Twycross, RG. and Wilcock, A. 2011. Palliative Care Formulary. 4th ed. Nottingham: Palliativedrugs.com Ltd.

Watson, MS., Lucas, CF., Hoy, AM. and Back, IN., (Eds) 2005. Oxford Handbook of Palliative Care Oxford: Oxford University Press.

Wilcock, A., Twycross, RG. and Toller, CS. 2001. Symptom Management in Advanced Cancer. 3rd ed rev. Milton Keynes: Radcliffe Publishing Ltd.