Using buses and trains during chemotherapy

Call 911 if you collapse, cannot be woken, or cannot get enough air. NCI states that infections during cancer treatment can be life threatening and require urgent medical attention, so this is not a situation for waiting and watching.

Phone your care team straight away if you develop a fever of 100.4 °F (38 °C) or higher, or any other sign of infection, while your counts are low. NCI's instruction is short and unambiguous: call your health care team if you have signs of an infection. Do this even if you feel otherwise reasonably well, and even if it is the middle of the night.

NCI's advice for avoiding germs during cancer treatment is two sentences long: "Stay away from people who are sick or have a cold. Avoid crowds and people who have just had a live vaccine, such as one for chicken pox, polio, or measles."

MedlinePlus, writing for people whose immunity is suppressed, says much the same: "Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit."

Notice that neither one mentions buses, trains, or transport of any kind. What they name is crowding and proximity to people who are unwell. A commute is only a problem to the extent that it delivers those two things.

A rush-hour carriage where you are pressed against strangers is a crowd. The same line at eleven in the morning, half empty, is not.

Most of the useful adjustments follow from that:

• Travel outside peak hours whenever your schedule allows.
• Walk down the platform to a quieter carriage rather than boarding the nearest door.
• Wait for the next service if one arrives full — the cost is a few minutes.
• Choose a seat with space around it over a seat in the middle of a full row.
• Book appointments at times that let you avoid the worst of the crush.

None of these require giving up independence, which matters. Being cut off from ordinary life is its own harm during a long treatment.

Avoiding crowds is a scheduling problem more than a transport problem.

NCI puts hand hygiene first in its infection guidance: "Wash your hands often and well. Use soap and warm water to wash your hands well, especially before eating."

On public transport you touch handrails, poles, ticket barriers, door buttons and seat backs — all touched by many other people. Those surfaces only matter because hands eventually go to faces and food.

So the habit that pays off most is simple: hands washed when you arrive, and definitely before you eat anything. If you are heading somewhere without a sink, carry something that lets you clean your hands on arrival.

You cannot control who sits near you. You can move, and moving is a reasonable thing to do. If somebody nearby is coughing steadily, change seats or change carriage. Nobody will notice, and NCI's advice to stay away from people who are sick is exactly this situation.

The masking question is worth asking your own team. MedlinePlus's guidance uses masks in the context of visitors with colds, and whether your team wants you masked while travelling will depend on how suppressed your immune system is at that point in your treatment.

Chemotherapy does not suppress counts evenly across a cycle. There is typically a stretch after each dose when counts fall furthest, and that is the period when crowd advice bites hardest.

Ask your team which days those are for your regimen. Knowing that you need to be careful for a specific handful of days each cycle is far more workable than trying to be careful all the time — and it means the rest of the cycle can look more like normal life.

Some people end up avoiding appointments because the journey is hard, not because they do not want to attend. If that is you, say it out loud at the clinic. Help with getting to treatment exists, and asking for it is not an imposition.