Cyclophosphamide Adriamycin & Vincristine (CAV) Chemotherapy

This section assumes you have already talked about other treatment options with your doctor and have agreed to a course of CAV chemotherapy.

It will explain:

• the treatment plan;
• the most common side effects you may have and ways in which you can reduce or even overcome them when you are at home;
• any serious side effects that may affect your life-style;
• who to contact when you need advice about the chemotherapy.

It will also be helpful for family and friends who may be worried at how the treatment may affect you and ways in which they can help.

Treatment Plan 1
Your treatment is given by the nurses and takes about 45 minutes. It is given as an infusion (drip) into a vein in the back of your hand or forearm using a plastic needle called a cannula. It is given every 3 weeks at the clinic for a maximum of 6 courses1. Your treatment should be pain free. However, if the skin around the cannula causes any pain, stinging or burning, tell the nurse immediately.

Side Effects 2
Nausea and Vomiting (feeling sick and being sick)
This may start a few hours to 48 hours after treatment unless you take your anti-emetics (anti-sickness) tablets as prescribed. You can help by eating small, frequent meals and avoiding rich, spicy foods and alcohol for 48 hours after treatment. If sickness lasts longer than this, telephone for advice and let your nurse or doctor know at the next hospital visit. A different anti-emetic may help. Some anti-emetics may cause drowsiness. If affected, it is important you do not drive or operate machinery.

Your Bone Marrow
Chemotherapy affects the bone marrow where blood cells are made and may temporarily lower the three main types of blood cells.

• Your white cells leaving you more prone to infection.
• Your red cells causing anaemia.
• Your platelets which may leave you prone to bruising or bleeding.

Because of this we will require blood tests each time you attend and in between at your nearest hospital. Telephone for advice if:

• your temperature rises above 37.5ºC (100ºF) which may mean an infection. The nurse will show you how to take your own temperature if you do not know;
• you have any bruising or bleeding you cannot account for;
• you feel tired or short of breath, which may mean you are anaemic and need a blood transfusion; or
• you feel generally unwell

Your Hair
Unfortunately, you will lose your hair and other body hair may also thin out. The nurse will arrange a wig for you if you wish. However, your hair will return once the chemotherapy is complete.

Your Mouth
Your mouth is prone to ulcers and infection so clean your teeth & gums after each meal. Avoid mouthwashes containing alcohol, because they increase dryness in your mouth. Salt water is good (1 tsp. to 1 pint boiled, cooled water) . If your mouth continues to be very sore or ulcerated, telephone for advice. You may experience taste changes which is unpleasant but harmless.

Tiredness
You may feel tired at times. It is important that you do as much or as little as you feel like doing.

Your Fertility
We advise you not to become pregnant or father a child during chemotherapy and for 2 months after the last treatment because the drugs may harm the developing baby. So, before starting treatment discuss methods of contraception with your partner and, if necessary, a nurse or doctor. However, your fertility in the future may also be greatly reduced or you may become infertile. For men - you may want to discuss sperm banking, with either your nurse or doctor who will arrange it for you.

Your skin
For several months after chemotherapy has finished, your skin may burn more easily. When in the sun, wear a high factor sun-cream (SPF 20 or more) and protective clothing. Occasionally, the vincristine causes pins and needles in your fingers or toes. Let the nurse or doctor know at your next visit. In the meantime, be careful you don't scald yourself.

Your Urine (waterworks)
You may find that for the first 24 hours following treatment your urine is red, but this is harmless. Very rarely, the chemotherapy can irritate the lining of your bladder. You can help by drinking at least 2 litres of fluid a day, but if you have pain, burning or notice blood when passing water, telephone for advice.

Your Bowels
Occasionally, the vincristine may cause constipation. Try a high fibre diet and drink at least 2 litres of fluid a day.

Your Heart
Very rarely, the chemotherapy can affect the muscle of the heart and if you already have heart problems, the doctor will monitor you carefully. Occasionally your doctor may arrange a special heart scan if there are any concerns.

Your Fingers and Toes
As treatment progresses, you may experience pins & needles in your fingers and toes. Although harmless, let the doctor know at your next visit, he/she may want to reduce or change the drug. In the meantime, be cautious with hot water and appliances. The sensation should disappear within 4-6 weeks of completing your chemotherapy.

It is hard to say which side effects will affect you and to what extent. Be guided by how you feel each day.

Who to Contact:
Delamere Day Case Unit 0151 604 7498. Mon - Fri, 9-5 Sulby Ward 0151 604 7459 all other times

References:
1. CCO 1999. Chemotherapy Protocols. Clatterbridge Centre for Oncology.
2. Cytotoxic Chemotherapy. 5th Edition. Eli Lilly Limited.

Further Reading:
CCO Patient Information Series:

• Chemotherapy (No.8)
• Sex and Chemotherapy (No.10)
• Hair Care Advice (No. 8D)
  

CancerBACUP leaflets.

• Chemotherapy
• Sexuality and Cancer
• Coping with Hair Loss
• Lung (Understanding Cancer Series)
  

Other Sources of Information:
Cancer Information Centre
Clatterbridge Centre for Oncology,
Bebington, Wirral CH63 4JY
Tel: 0151 482 7722.
www.ccotrust.co.uk

BACUP
3 Bath Place
Rivington St
London EC2A 3JR Tel.0800 181199
www.cancerbacup.org.uk

Taxol

Taxol & Cisplatin

Taxol & Carboplatin

CAE

Adriamycin

BMC

Carboplatin

5FU & Folinic Acid

AC

CAV

Cisplatin

CMF

CMV

Epirubicin

Irinotecan

Mitozantrone