Your doctor has explained that you have cancer and has recommended treatment with chemotherapy, which includes a drug called Navelbine. It is given as an injection or as an infusion through a fine tube (cannula) inserted into a vein (intravenously), via a drip, over a short period of time. It may occasionally also be given through a central line which is inserted into a vein near the collar bone.
The chemotherapy drug you are going to have is called vinorelbine. This treatment is given weekly for 18 weeks, by injection through a vein.
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.
We have outlined side-effects you may experience
during treatment. It is important that you feel free to ask questions so that
you understand what to expect and what to do. Occasionally people have rare
side-effects which are not expected or mentioned on this sheet.
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 count falls you may experience the following:
White Blood Cells (WBC). Shivering or
shaking attacks of fever. If you feel hot or unwell check your temperature.
If it is 38°C (100F) telephone the Hospital and they will advise you. Do not
take Paracetamol or Aspirin if you have a temperature.
temperature indicates infection which could be life threatening. If
you have a temperature or feel unwell contact your hospital immediately.
Haemoglobin (Hb) Tiredness, lethargy,
breathlessness, dizziness (particularly on standing) and pale facial colour.
Occasionally patients require a blood transfusion.
Platelets If you notice any bleeding, i.e. nose bleeds, unexplained bleeding, bruising or persistent headaches contact the Hospital immediately.
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 are 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.
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 dietary intake.
Weight loss may also be experienced by some patients during their course of chemotherapy , in these cases dietary advice should be sought.
Hair loss; This chemotherapy does not usually cause hair loss. Thinning may occur 3-4 weeks after the first course, but is rarely enough to require a wig.
Sore mouth; You may have a sore mouth after chemotherapy and it is important that you maintain good oral hygiene. A soft, baby toothbrush and a mouthwash may help. If you develop mouth ulcers you must contact your clinic and they will prescribe special mouthwashes to help.
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.
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.
Some patients might experience leaking around the vein. If Vinorelbine leaks into the tissues around the vein, it can damage tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell the doctor or nurse. If the area around the cannula site becomes red or swollen at any time, you should tell your doctor or nurse.
Altered sensation; This 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.
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.
Fertility may be affected by chemotherapy, in both men and women. It is important to discuss fertility with your doctor before starting treatment. 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 it will damage a growing baby. You should still take contraceptive precautions even if your periods have stopped, as you could still become pregnant. Men must also use a barrier contraceptive whilst receiving chemotherapy as sperm is damaged by chemotherapy.
Steroids; The Prednisolone tablets are a form of steroid and some people feel hyperactive and have trouble sleeping while they are taking them. Taking the tablets earlier in the day will help prevent this. If you normally have indigestion your doctor may give you tablets to prevent indigestion with steroids.
Three types of damage can occur, listed in order of seriousness:
You may experience darkening of the veins in your hands and arms. This is normal, usually doesn't hurt and should fade once your course of treatment has been completed
Towards the end of your chemotherapy course, some veins may feel hard and 'cord-like'. In these veins the blood has clotted (superficial thrombosis) which may take several months to resolve. Your doctor may recommend a low dose of aspirin (ask before taking it yourself).
These chemotherapy drugs can cause irritation and tissue damage if they leak out of the vein whilst injected. This is called extravasation. All nurses who administer chemotherapy have completed an intensive training programme and are fully aware of what to do if extravasation occurs. Rarely problems can start after you have left the Hospital. Look out for pain, stinging or burning sensations, redness or swelling around the area where the chemotherapy was given. If you notice any of these symptoms after you have left the Hospital, contact the emergency numbers you have been given. In the meantime, keep the arm raised and place a cool (not ice) pack on the area.
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.
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.