Epirubicin Chemotherapy

This section assumes you have already talked about other treatment options with your doctor and have agreed to a course of epirubicin 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 20 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 4 or 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
You will probably lose the hair on your head and other body hair may thin out. The nurse will arrange a wig for you. However, hair loss is temporary and 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.

Tiredness
You may feel tired at times. It is important that you do as much or as little as you feel like doing. You may need to take time off work.

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.

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. The treatment may also cause your nails to develop ridges. This is temporary and will eventually grow out.

Your Urine (waterworks)
You may find that for the first 24 hours following treatment, your urine is red. This is harmless.

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 ed. Lilly Oncology

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