Capecitabine & Oxaliplatin Chemotherapy (CapOx) A Guide for Patients

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1 This leaflet has been designed to help you and your family understand more about the chemotherapy that you are about to have as treatment for your cancer. If you need more information or have further questions, please do not hesitate to ask your hospital doctor or chemotherapy nurse. What is cancer? Our bodies are made up of tiny structures called cells that cannot be seen by the naked eye. Normally these cells reproduce themselves by dividing in a regular fashion. This allows growth and repair of body tissues. Sometimes uncontrolled growth of cells occurs. This is what happens in cancer. What is Chemotherapy? Chemotherapy means treatment with medicines called cytotoxic drugs that are given to get rid of or control cancer cells. How do chemotherapy drugs work? The drugs enter the bloodstream and go to all parts of your body. They destroy the cancer cells by interfering with their ability to grow and divide. The drugs can also affect normal cells that are growing and dividing. This may cause side effects but these are usually temporary because healthy cells can grow back to normal. What can I do while having this treatment? You can usually get on with life as normal. As long as you feel well enough you can carry on working and doing your favourite activities and hobbies. You should discuss this with the hospital doctor or your nurse caring for you. If it fits in around your treatments you can go on holiday in the UK, but please discuss any plans with your doctor or nurse before booking a holiday. You can eat and drink as normal and you can drink alcohol in moderation. We advise that you avoid cold drinks when you have Oxaliplatin and for a few days afterwards. You may find that the taste of food and drinks may change. This will go back to normal once your treatment is finished. You will be asked to have blood tests taken before each visit to let us check that we are able to give you your chemotherapy. The practice nurse at your GP surgery can do this the day before treatment. Your nurse will discuss this with you at your first chemotherapy visit. Page 1 of 5

2 What is Capecitabine and Oxaliplatin? These are the names of the chemotherapy drugs that you will have. You will come to ward 1 every 3 weeks. Oxaliplatin is given through a drip over 2 hours. Capecitabine is the name of the chemotherapy tablets that you will have. You will be given enough tablets to take twice a day for 14 days. You will then have 7 days at home taking no tablets. This is 1 cycle of treatment. The number of chemotherapy cycles given depends on your treatment plan. Your nurse and doctor will discuss this with you. Arrangements for review of any side effects during the first cycle (telephone call or clinic visit) will be made when you come for your first treatment. How do I take the Capecitabine tablets? The tablets must not be split and must be swallowed whole. They must be taken with food or within 30 minutes after eating food, and should be swallowed with a large glass of water (not fruit juice). If you vomit for any reason after taking your tablets do not take another tablet to replace these. You should leave 12 hours in between each dose. If you miss a dose for any reason, do not add on treatment days to the planned 14 days. Return any unused tablets to the hospital. Will I have any side effects? With most types of chemotherapy it is likely that you will have at least some side effects, although this varies considerably from patient to patient. Please tell your chemotherapy nurse at your next visit about any side effects that you have had. We will try to reduce them. Below are some of the side effects, which you may have: Arm discomfort during Oxaliplatin infusion Some patients find that they have an uncomfortable arm while the Oxaliplatin drip is running. We usually use a heat pack over your vein while the drip is running. If your arm becomes sore at any time please tell a nurse straight away. We may recommend increasing the time that your drip takes to 4 or 6 hours. Laryngeal Spasm Some people have a sensation of difficulty swallowing and breathing while the drip is running or immediately afterwards. Warm drinks often help this and we advise that during and for at least 24 hours after treatment you avoid cold drinks. If it happens please tell your nurse. We may recommend increasing the time that your drip takes to 4 or 6 hours. Page 2 of 5

3 Jelly legs Occasionally people feel wobbly after oxaliplatin and need to rest for a while before going home. We recommend that you do not drive yourself in for your first chemotherapy appointment. Cold related numbness, pain in your hands or feet or around your mouth. During, immediately after and for up to a week after you have had Oxaliplatin, it is common to have numbness or pain in your hands, feet or around your mouth if they get cold. We advise that you should wear gloves and a scarf if needed and avoid cold things. Numbness and tingling in hands or feet This is very common and normally goes away around 7 days after each treatment. It may become more obvious after a number of treatments and may be made worse by the cold. It is very important that you tell us if numbness or tingling affects your day-today activities, especially if it lasts until your next treatment is due. It can get worse after the end of your treatment. It usually goes away when you finish your treatment but can take several months. Nausea (feeling sick) and Vomiting Some patients can have nausea and vomiting. There are very effective medicines for nausea/vomiting that we will give you in case you need them. It is important to drink lots of fluids after chemotherapy so if the sickness or nausea is not controlled or is reducing the amount you can drink, please contact your G.P. Please tell your nurse on your next visit if you have had problems with nausea or vomiting so that we can give you different anti-sickness medicines. If you are sick more than once in 24 hours, please stop taking the Capecitabine and contact your GP or the hospital. Diarrhoea (loose or watery bowel movements) This chemotherapy can cause diarrhoea, but it is usually mild and controlled by the anti-diarrhoea medicine (loperamide) we will give you. If you have 4 bowel motions more than usual during the day, or if you have diarrhoea at night, or cramping tummy pain, you must stop taking your Capecitabine. Take loperamide. Drink plenty of fluids. Contact your GP or the hospital. You may need admitted for intravenous fluids. Sore mouth Mouth ulcers can occur inside and outside the mouth. We advise that you keep your mouth clean using a new, soft toothbrush. Your nurse will give you advice about mouthwashes that you can use if needed. If you develop ulcers and have discomfort when eating or drinking, stop taking your Capecitabine and contact your GP or the hospital. Sometimes people notice bloody mucus when they blow their nose. If you notice prolonged bleeding contact your GP. Soreness and Redness of Hands and Feet This is a temporary side effect and improves once the treatment is finished. We advise that you use a moisturising cream. Tell your nurse if you have it. If you find that your hands or feet become sore and interfere with your normal daily activities, stop taking your Capecitabine and contact your GP or the hospital. Page 3 of 5

4 Skin changes. Sometimes your skin can become itchy and/or a rash may develop. Contact your G.P. for advice if needed and tell your nurse at your next visit. Increased risk of infection Following chemotherapy, your white blood cells can become low at any time after treatment.. If your temperature goes above 38 C (100.5 F) or if you suddenly feel unwell, even with a normal temperature contact your G.P. or NHS 24 straight away. Chest Pain (Angina) Very occasionally capecitabine can cause chest pain. If you develop pain or tightness in your chest that may also spread to your neck, jaw or arm and you also feel sick or sweaty, call your GP or 999 immediately. Stop your Capecitabine. Please tell the doctor that you have been taking capecitabine and ask them to contact the oncology registrar for advice. Don t restart your Capecitabine until review by/ discussion with the oncology team. Temporary hair thinning You may notice an increased amount of hair in your hairbrush at times after treatment. It is unlikely that this will be enough to need a wig. However, if you feel that you need a wig at any time please speak with your nurse. Fertility The drugs used in this chemotherapy regimen can affect your fertility. Women may find that their periods become irregular and may have an early menopause. If you wish to plan a family you should discuss this further with your consultant before starting your chemotherapy. It is possible to have a normal sex life during treatment, however some people may find that their interest decreases. It is very important that you use barrier contraception to avoid pregnancy. Please refer to the specific patient information leaflet about this. Fatigue It is very common for people on chemotherapy to feel excessively tired at times. This tiredness (or fatigue) may get worse as you go through treatment. There are things that can be done to make things better so if you feel more tired than usual, please talk to your doctor or nurse. They can give you advice about coping with it. Interactions with other medicines Please tell your doctor if you are taking any of the following medicines as they can interact with your chemotherapy: Allopurinol, Folic acid (a vitamin that can be in multivitamin tablets), Phenytoin, Warfarin. Let your doctor know if you are on warfarin as the blood test to check how thin your blood is (INR) will need to be checked more often. Your GP can do this. Page 4 of 5

5 We hope that this information has helped you understand more about your chemotherapy. This leaflet is designed to be used along with discussion with your doctor and nurse. It should not be the only information that you are given. Contact Numbers: For symptom advice: Ward 1 (Mon-Fri8.30 am 6pm) For queries about appointments, booking transport, or phoning in your weight: Ward 1 (Mon-Fri 8.30 am 6pm) Out of Hours Emergency Advice: Phone NHS 24 on Remember to tell them you are having chemotherapy. If your GP needs further advice, the oncology registrar on call can be contacted by phoning the Western General Hospital switchboard on Other phone numbers specific to your care: Page 5 of 5

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