Docetaxel and cyclophosphamide chemotherapy guide For patients with breast cancer 1 Table of Contents What is chemotherapy? ..................................... 4 What should I discuss with my doctor before starting chemotherapy ....................................... 5 What are docetaxel and cyclophosphamide? ..... 9 How should I prepare for treatment? .................. 9 What can I expect during my treatment? .......... 10 What are the common side effects of docetaxel and cyclophosphamide treatment? .................. 12 How do I manage common side effects? ......... 13 Where can I get support? ................................. 32 2 Your health care team Oncologist: _______________________________ Pharmacist: _______________________________ Nurse: _______________________________ Dietitian: _______________________________ Social worker: ___________________________________ Medical Day Care: 416-864-5222 2 Donnelly Nursing Unit: 416-864-5099 3 What is chemotherapy? Chemotherapy is a type of treatment for cancer. Chemotherapy can be a single drug or it can be a few types of drugs at the same time. When used alone or along with surgery or radiation therapy, chemotherapy can often shrink a tumour or prevent its spread. How does it work? Chemotherapy kills cells that grow quickly. This is why it kills cancer cells. But it also affects healthy cells that grow fast. This includes cells in the mouth and stomach lining, bone marrow, skin and hair. This is why patients having chemotherapy treatment get side effects such as hair loss, nausea and low blood cell counts. As a rule, chemotherapy is given in cycles of treatment. There is a time of no treatment between cycles. This lets normal cells recover before the next cycle begins. 4 What should I discuss with my doctor before starting chemotherapy? Your health history • Tell your oncologist about any other health problems you have or had. Some health problems may affect the outcomes with this treatment. • Tell other healthcare professionals you are seeing about the type of chemotherapy you are having. Vaccines, surgery and dental work • You should have all your dental work done before you start your treatment. • Check with your oncologist before you have any vaccines, surgery or dental treatment. 5 Other medicines, herbs and supplements • Tell your oncologist, chemotherapy nurse, dietitian and pharmacist about any over the counter, herbal or doctor-prescribed medicines or vitamins you are taking. • Check with your oncologist, chemotherapy nurse, dietitian or pharmacist before you start taking any new drugs, including vitamins and herbal or alternative treatments. • Tell your oncologist if you are taking ASA (Aspirin®), ibuprofen (Advil® or Motrin®), acetaminophen (Tylenol®), naproxen (Aleve®) or blood thinners. 6 Your menstrual cycles (periods) • Your periods may become heavier or lighter. This change could be permanent. • You may develop symptoms of menopause such as hot flashes, vaginal dryness, mood swings and changes in sexual desire. Talk to your doctor about these symptoms if they bother you. Birth Control • Women who have not yet reached menopause should take steps to avoid getting pregnant while being treated. Chemotherapy may harm your baby. • Talk to your oncologist about what kind of birth control you can use to make sure you do not become pregnant. 7 Pregnancy and fertility • If you want to have children, speak to your oncologist before starting your first treatment. Chemotherapy may affect your chances of having a baby in the future. • Tell your oncologist as soon as possible if you become pregnant. Breastfeeding • If you have a baby, do not breastfeed while being treated with chemotherapy. Ask your oncologist how long you should wait to breastfeed after your final chemotherapy treatment. Ask your chemotherapy nurse, pharmacist or oncologist if you have any questions. 8 What are docetaxel and cyclophosphamide? Docetaxel and cyclophosphamide are the names of chemotherapy drugs, used together, to treat breast cancer. They are both liquids and are given through a needle in your arm. One cycle of docetaxel and cyclophosphamide is 3 weeks (21 days). You will be considered for treatment once every 3 weeks for 4 cycles. How should I prepare for treatment? Before starting each docetaxel and cyclophosphamide treatment, your doctor will give you a prescription for dexamethasone tablets to help prevent some of the side effects. Start taking your dexamethasone tablets the morning and night before your chemotherapy treatments. Follow your doctor’s instructions on how to take these medicines. While being treated, do not eat grapefruit, starfruit or seville orange and the juices and products made from them. They may increase your side effects. Otherwise, most patients can eat and drink as normal before treatments. Your oncologist will tell you if you need to change what you eat. 9 What can I expect during my treatment? On the day of your treatments you will come to the Medical Day Care Unit: 1. You will have a blood test before each treatment to check your blood counts. Low blood counts can mean your body will not be able to handle another dose of chemotherapy and your treatment may be delayed. 2. In the Medical Day Care Unit a chemotherapy nurse will give you docetaxel and cyclophosphamide through a needle into your arm. 3. Tell your chemotherapy nurse right away if you feel any burning or pain around the needle site when having your chemotherapy. Docetaxel can cause damage to tissue around the needle if it leaks out. 4. Tell your chemotherapy nurse if, during your treatment, you: Feel short of breath Have pains in your chest Notice itching, swelling or severe rash These can be signs that you might be allergic to docetaxel. Go to the emergency room right 10 away if you have these symptoms after you leave the Medical Day Care Unit. 5. Once your treatment is done you can go home. 11 What are the common side effects of docetaxel and cyclophosphamide treatment? Side effects of chemotherapy depend on the types of drugs used and how your body reacts to those drugs. Nausea (sickness in stomach) and vomiting Hair thinning Numbness or tingling in the hands or feet Fatigue (tiredness and weakness) Pain in the muscles or joints Diarrhea Mild swelling in arms and legs (puffiness) Sores in your mouth Infection (fever, chills, cough, sore throat) Unusual bleeding or bruising Heartburn Watery eyes Nail changes Dry itchy skin Pain with urination 12 How do I manage common side effects? Nausea and vomiting Nausea and vomiting is common with the docetaxel and cyclophosphamide treatment. It is usually the worst during the first 12 to 48 hours after treatment and often gets better in 3 to 7 days. You may be given a prescription for medicine to take before your chemotherapy treatment to prevent nausea and vomiting. You may also get a prescription for medicine to take if you have nausea or vomiting even though you already took the prevention medicine. This is called rescue medicine. Your pharmacist will explain these medicines to you. What you can do • Try to take your rescue medicine for nausea and vomiting as soon as you start to feel nauseated or 30 minutes before a certain time you think you will have nausea and vomiting (for example before dinner time). • If you vomit within 30 minutes of taking your anti-nausea pills or see a pill come up, you can take another pill. • Drink lots of liquids. 13 • Get fresh air and plenty of rest. • Eat small meals often and limit spicy, strong smelling foods. When to get help If you vomit for more than 24 hours or feel nausea longer than 48 hours, even though you are taking your nausea medicine, contact your doctor or nurse. 14 Hair thinning Hair thinning usually starts 2 to 3 weeks after your first treatment. Your scalp may feel tingly as your hair is falling out. What you can do • Use a gentle shampoo and a soft hair brush. • Avoid using dyes, perms, bleaches and hair sprays until 6 months after your last chemotherapy treatment. • Protect your scalp from sun exposure and cold weather. • Consider cutting your hair short before it falls out. • Ask your chemotherapy nurse for information about wigs and head coverings. 15 Numbness and tingling in hands and feet Numbness and tingling is caused by the effects of docetaxel on your nerves. Your feeling may slowly return to normal after treatment ends. Contact your doctor if you • Have trouble doing up buttons, writing or picking up small objects • Have pain or difficulty moving your hands and feet 16 Tiredness and weakness Feeling tired and weak is most common after the first 7 days of each cycle. You may feel more and more tired with each treatment. It takes a few months for the tiredness to go away even after your treatment has ended. Your energy level will improve over time. A low red blood cell level can also make you tired. When your oncologist does blood work they will monitor your red blood cells. What you can do Eat well-balanced meals. Do mild exercise such as walking. Be sure to rest well when you need to. Call your doctor or nurse if you Have shortness of breath Fall and hurt yourself Feel dizzy when walking or when getting up out of bed 17 Muscle and joint pain You may have muscle and joint pain for a few days after each treatment. What you can do • Take any medicines your doctor prescribed you for pain. Follow your doctor or pharmacist’s instructions. • If your pain becomes unbearable, ask your oncologist or clinic pharmacist if you can take acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®). Your oncologist may prescribe a medicine for your pain instead. • Rest when you need to and try doing light exercise. 18 Diarrhea (loose watery stools) What you can do • To treat diarrhea you may use loperamide (Imodium®) or a stronger anti-diarrhea medicine called Lomotil®.