Cyclophosphamide, Methotrexate & 5FU (CMF)
Chemotherapy for Breast Cancer

This section assumes you have already talked about other treatment options with your doctor and have agreed to a course of CMF 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
You will be given tablets (cyclophosphamide) for the first 10 or 14 days, which are supplied by the hospital. Do not ask your GP for any more. Start them on the second day and avoid nighttime. On days 1 and 8, the nurse will give you an injection into a vein in the back of your hand or forearm using a small needle called a butterfly. It takes about 10 minutes. After the 2nd injection you will have a 2-week rest before starting again. This will be repeated for 4 or 6 courses.

Side Effects 2
Nausea and Vomiting (feeling sick and being sick)
It is important to take your anti-emetics (anti-sickness) tablets as prescribed, otherwise nausea and less frequently vomiting, may become a problem. 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
1 in 3 people will experience some hair loss. If this happens, the nurse will arrange a wig for you. This is temporary and your hair will return once chemotherapy is complete.

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. The treatment may also affect your fertility in the future and cause an early menopause.

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 also get a metallic taste in your mouth. It 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 Bladder (waterworks)
The chemotherapy tablets 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 Skin
For several months after chemotherapy has finished, your skin may burn more easily that normal. In the sun, wear a high factor sun-cream (SPF 20 or more) and protective clothing. Your skin may also darken, especially over the veins used for treatment, because of an excess production of pigment. This will return to normal within a few months after chemotherapy has finished.

Your Weight
Some of the treatment may cause you to gain weight. Whilst this may cause you some concern, you can lose it again when treatment is finished.

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. The Royal Marsden Hospital (1995) Handbook of Adult Cancer Chemotherapy Schedules. Rhone-Poulenc Rorer

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
• Breast - Primary
• Breast - Secondary.
  

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