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Your doctor has explained that you have breast cancer and has recommended treatment with chemotherapy.
The chemotherapy regimen recommended to you is called FEC - Taxotere. This usually consists of 3-4 cycles of FEC (5Fluorouracil, Epirubicin and Cyclophosphamide) which is given every three weeks following by the single agent taxotere again 3-4 four cycles given every three weeks. Both treatment are given as slow injections into a vein, as an outpatient. Occasionally it is difficult to access the veins in the arm so a central line (portacath or hickman) or PICC line is inserted.
Before each course of chemotherapy you will see a doctor and have a blood test. If your blood count is low then chemotherapy may be delayed a few days or the dose reduced, occasionally injections of growth factors are required for a few days after chemotherapy to boost your blood counts.
The side-effects described below will not affect everyone. We have outlined
those that you may experience during treatment which can occur with both the FEC
and Taxotere phases. Nausea is usually a little worse with FEC but nail changes
and aches and pains are worse with taxotere. Your clinic staff will usually
work with you to keep your side-effects to a minimum. It is important that you
feel free to ask questions so that you understand what is happening, what to do
and what to expect. Occasionally people have rare side-effects which are not
expected or mentioned on this sheet. If
in doubt please ask!
Nausea & sickness; Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different tablets can be prescribed for the next cycle. Some self help tips may also be useful.If your blood counts falls you may experience the following:
White Blood Cells (WBC) Shivering or shaking attacks of fever (flu like symptoms). If you feel hot or unwell check your temperature. A raised temperature indicates you have an infection which could be life threatening. A normal temperature is between 36oC and 37.2oC. If it is 38°C (100F) telephone the Hospital or cancer unit immediately and they will advise you. Do not take Paracetamol or Aspirin as this will bring your temperature down and mask the signs of infection. This is most likely to happen in the middle week (7-14 days) between cycles.
Haemoglobin (Hb) Tiredness, lethargy, breathlessness, dizziness (particularly on standing) and pale facial colour. Occasionally patients require a blood transfusion at some point during the whole course.
If you notice any bleeding, i.e. nose
bleeds, unexplained bleeding, bruising or persistent headaches contact the
Other advice on paracetamol; As mentioned above, if you have a temperature and feel unwell you may have an infection and may need treatment in hospital, we advise not to take paracetamol in this situation as it may mask your temperature, give false reassurance and delay you presenting to hospital for treatment. Taking paracetamol can otherwise be used with discretion. If for example you have a headache or a mild pain but otherwise feel well and your temperature is normal paracetamol can be used provided you check your temperature before each dose and allow a full six hours before each administration.
Contact to chicken pox; If you can't remember whether you've had Chicken Pox as a child and you come in contact with a person who as it or shingles you should contact your oncology team. They will arrange a blood test to find out if you are immune to chicken pox (the varcella virus). If not a series of injections can be administered to offer you temporary immunity
Fatigue; All chemotherapy can cause fatigue. As your treatment progresses you will experience this. You may find that gentle exercise such as a short walk each day (if you are not working) may help. Fatigue and malaise may last up to 2-3 months (or longer) after the end of chemotherapy.
Aching muscles and joints; You may experience pain in the muscles and joints within two to three days of having your taxotere infusion, but usually resolves quite quickly. Pain-killers can be used as advised.
Weight gain; Over the entire course of chemotherapy many patients complain of weight gain. This is caused by a combination of the steroids increasing the appetite, the fatigue causing lack of mobility and the mild nausea often encouraging to nibble rather than eating correct meals - In order to prevent this we recommend regular light exercise and be aware of your calorie intake.
Weight loss may also be experienced by some patients during their course of chemotherapy particularly if there is more advances disease or other medical problems, in these cases dietary advice should be sought.
mouth; You may have a sore
mouth after chemotherapy and it is important that you maintain good
oral hygiene. A soft, baby toothbrush may help and you may be given a mouthwash.
If you develop mouth ulcers
you should contact your clinic and they can prescribe special mouthwashes to
Red urine; The epirubicin injection is coloured red. You may notice that the first time you pass urine after chemotherapy that it is alsoncoloured red - this is normal.
Altered taste; You may also experience an alteration in your taste. Food may taste slightly more salty, bitter or metallic. Normal taste will return once you treatment has finished, but may take several months to do so
Hair loss; This chemotherapy does cause hair loss. It usually starts 3-4 weeks after the first course and may be lost completely. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will regrow after treatment, although it may at first be a different texture, very like a baby's hair. Some departments use a cold cap system to minimise hair loss. Your clinic nurse can arrange for you to have a wig before your treatment starts (NHS prescription charge, prices are approximately £55 for an acrylic wig, £140 for half real hair wig and £205 for a full real hair wig).
Premature menopause; For pre-menopausal women, chemotherapy may affect your periods. They may become heavier, lighter or may stop. In some women this may be permanent causing menopausal symptoms. You should not become pregnant during chemotherapy, as chemotherapy will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant.
Constipation; Some patients experience constipation which may be due to the anti-sickness tablets. You should drink plenty of fluids, eat a high fibre diet and take gentle exercise. If this is severe you should contact your clinic or GP.
Steroids; This chemotherapy is given with steroids (e.g. Dexamethasone) to help prevent sickness. Steroids have some side effects, including fluid retention, weight gain, wakefulness and sometimes agitation. If you suffer from indigestion you may be given tablets to prevent this. If patients are prone to "spots" or acne this can be made worse. Likewise they can temporarily upset diabetes or high blood pressure.
Diarrhoea; This chemotherapy can cause diarrhoea, which can be easily controlled with medicine, but you should inform your doctor if it is severe or continues. It is important to drink plenty of fluids if you do get diarrhoea. If you have any alteration in bowel pattern tell your doctor.
Sensitive eyes; You may find your eyes become more sensitive to light and that they start "watering". If this occurs your clinic may prescribe you some eye drops.
Very rarely this chemotherapy can damage
the heart. A heart (cardiac) function test may be performed before or during
chemotherapy. The risks are very small provided the recommended maximum dose of
the medication is not exceeded. To ease the strain on the heart, if you smoke,
it is strongly recommended that you stop smoking.
chemotherapy can irritate the nerve endings and some people notice altered
sensation with slight numbness or pins and needles in the fingers or
toes. This comes on slowly, is usually mild and will usually get better slowly
after chemotherapy has finished. If the numbness is severe it may interfere with
fine movement (e.g. fastening buttons). If you develop sudden numbness or
weakness this should always be reported immediately.
After several treatment
cycles you may experience discolouration (a change in the colour) of your nails
(see below). Your
hands and feet may become dry and flaky, but this can be managed by using a
glycerine-based hand cream, which your nurse can supply.
Three types of damage can occur, listed in order of seriousness:
Increase risk of blood clots - during chemotherapy there is an increased risk of blood clots, most commonly in the legs (deep vein thrombosis) or more seriously to the lungs (pulmonary embolus). If you get unexplained swelling and discomfort in the calf report this to the oncology unit. Likewise if you start experiencing unexplained breathlessness, cough up any blood or have a pain in the chest particularly when you breath contact the clinic as soon as possible. To avoid clots its important to stay as active as possible and (exercise & chemotherapy) taking light walks two to three times a day and avoid sitting around for long periods of time. If you are required to sit (for example while receiving the chemotherapy drugs) try to move your legs and ankles regularly. Occasionally, if your doctor feels you are at high risk of developing clots you may be started on drugs to thin your blood during chemotherapy.
Sore eyes; The front of the eyes (cornea) can occasionally feel dry and sticky, especially first thing in the morning. This usually comes on later in the course and can cause some redness and discomfort. Eye drops such artificial tears can be bought over the counter or prescribed by your medical team.
Nails; The grow of the nails can be impaired by chemotherapy. The amount of damage can vary but in most case there will be some slight discolouration and indentation seen in ridges across the nail beds - a bit like the rings of a tree, each representing an individual chemotherapy cycle. Occasionally the damage can be more troublesome, causing pain and breakdown of the nail bed causing it to lift and separate, possibly even leading to a total loss of the nail. Eventually after chemotherapy has finished the nail will grow back normally. Many patients report that massaging the nails beds with a natural oil can help (see nail care guidelines)
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