A1023, A1601, A1228, A1229
Information leaflet on Epirubicin, Cyclophosphamide and Paclitaxel chemotherapy
This leaflet provides information on Epirubicin, Cyclophosphamide and Paclitaxel chemotherapy. It will explain what this is and when and how it is given. It will also tell you about possible side effects. Contact telephone numbers and details of how to obtain further information on Epirubicin, Cyclophosphamide and Paclitaxel are given at the end of the leaflet.
This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ folder. If you haven’t received this folder please ask your nurse for a copy.
Your ‘specialist team’ refers to your oncology team at Velindre Cancer Centre which includes doctors, specialist nurses and non-medical independent prescribers which may be a nurse or a pharmacist.
What is Epirubicin, Cyclophosphamide and Paclitaxel?
This is a course of treatment made up of 3 drugs.
Epirubicin and Cyclophosphamide (EC) for up to 4 cycles followed by Paclitaxel for up to 4 cycles.
All these chemotherapies are given through a drip into a vein.
Why am I having Epirubicin, Cyclophosphamide and Paclitaxel?
Your team has prescribed this chemotherapy because it has been found to be effective in treating your type of cancer.
How often will I receive my Epirubicin, Cyclophosphamide and Paclitaxel?
For this treatment to be most effective it is given at specific time intervals. These are known as cycles.
You will either have:
Epirubicin and Cyclophosphamide (EC) every 2 weeks. Following EC you will receive paclitaxel every 2 weeks. The treatment will take approximately 16 weeks
Or
Epirubicin and Cyclophosphamide (EC) every 3 weeks. Following EC you will receive paclitaxel every week. The treatment will take approximately 18 weeks.
The team will explain to you how often you will receive your treatment and how many cycles you will have.
How often will I see the specialist team?
You will be reviewed by your specialist team before each cycle. You will either see your specialist team in clinic or you will speak to them virtually.
You will have blood tests prior to each treatment and we will check how you are feeling and discuss any problems you may have. This is so we can check how the chemotherapy is affecting you. If your blood results are satisfactory, your chemotherapy will be prescribed.
How will my treatment be given?
Your treatment will be given through a drip into a vein. We may suggest that a fine tube called a PICC line, or alternative central line is inserted. These lines will remain in place throughout your treatment. Your doctor or nurse will discuss this with you and give you a leaflet, if required.
Where will my treatment be given?
The treatments will be given in the day case treatment areas at Velindre Cancer Centre, or in one of our SACT Outreach Clinics.
How long will I be in the hospital?
Your treatment will be on a different day to your clinic appointment. You treatment will take approximately:
Please allow extra time for your first treatment. If you choose to use scalp cooling you will need to allow an extra 1.5 hours for each treatment visit.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is only enough space for one other person. Treatment areas are not suitable for young children.
What are the possible side effects?
There are a number of possible side effects which can occur. The team can give you advice or answer any questions you may have.
Hair loss
Both EC and Paclitaxel cause hair loss. This is only temporary. Your hair will grow back when your treatment has finished. A method known as ‘scalp cooling’ or ‘cold capping’ can be used to prevent hair loss. We can arrange a wig if you would like one. If you would like more information about wigs or scalp cooling please speak to your nurse.
Sickness
Nausea and vomiting are known side effects of this treatment. However we will give you anti-sickness medicines which are usually extremely effective. If you have a persistent feeling of sickness or are sick more than once in 24 hours despite taking regular anti-sickness medicine contact Velindre Cancer Centre. The telephone number is at the end of the leaflet.
Infection
You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or if your temperature is below 35.5°. The telephone number is at the end of the leaflet.
You may be given an injection to boost your white blood cells which aims to reduce your risk of infection. The injection is given at home in the days after your chemotherapy has finished and can be given by a community nurse, relative or by yourself. Your specialist team will explain this further.
Diarrhoea
Diarrhoea is not common with this treatment. However, if you have 4 or more bowel movements in 24 hours above what is normal for you, contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
Tiredness and fatigue
You may feel more tired than usual. It is important to listen to your body and rest if you need to but carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as rest.
Allergic type reaction
A small number of patients experience an allergic type reaction to paclitaxel. If this occurs you may feel hot or flushed, itchy, light-headed or generally unwell whilst receiving paclitaxel. This can be easily treated. Please tell your nurse immediately if you experience any of the above symptoms.
Skin and tissue damage
Some chemotherapy drugs may damage the skin and surrounding area if they leak outside of your vein. This is known as extravasation. It is extremely rare but it is important that you tell us immediately if you notice any swelling, pain or burning at the site of the drip. If this occurs whilst the chemotherapy is being given, tell your nurse. If you notice pain, swelling, or redness when you’re at home please contact us immediately. The telephone number is at the end of the leaflet.
Vein pain and phlebitis
The epirubicin chemotherapy can cause some irritation to the vein as it is injected. If you are having treatment through a drip needle in your hand or arm you may notice some discomfort at the time of the injections of chemotherapy. Please tell your nurse immediately if this occurs.
For a small number of patients this vein irritation can result in some tenderness, hardness and scarring of the vein which can last for weeks or months after the treatment. The risk of this can be reduced by alternating the arm in which the chemotherapy is given. Having chemotherapy through a PICC line will prevent this problem.
Colour changes to your urine
Epirubicin will harmlessly discolour your urine red for a day after your chemotherapy. If this lasts for more than 24 hours please contact the treatment helpline. The number is at the end of the leaflet.
Effects on your heart
Epirubicin can cause heart problems for a small number of patients. If you have an existing heart problem please tell the team before you start treatment. If you experience any new problems with breathlessness, palpitations or chest pain you should seek urgent medical attention.
Effects on the nerves of your hands and feet
Paclitaxel can affect the nerves of your hands and feet. This may lead to a loss of sensation, tingling or pins and needles. If this occurs please tell your doctor or nurse at your next clinic visit as we may need to change your treatment.
These symptoms may increase as you have more cycles of chemotherapy. If you have these symptoms, it is important to be extra careful when exposing your hands and feet to hot or cold temperatures. These symptoms usually go away within a few months of finishing your treatment
Myalgia (pain in the muscles)
After paclitaxel some patients may experience myalgia which is muscle or joint pain. This can sometimes be severe but will only last for a few days. If you already have painkillers at home you may find they relieve the pain. If this does not work please contact Velindre Cancer Centre. The telephone number is at the end of the leaflet.
Pregnancy and breastfeeding
It is important that you do not become pregnant or father a child during your course of chemotherapy treatment, or for at least six months after treatment. This is because chemotherapy can harm an unborn child.
Breastfeeding during chemotherapy is not advised as the drugs could be passed to a baby through breast milk.
Risk of blood clots
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to seek medical help immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information
Alcohol content of paclitaxel
Paclitaxel contains alcohol. If having alcohol is a problem for you, tell your doctor, nurse or pharmacist. It is possible that your blood alcohol level may be above the legal limit after you have paclitaxel. Do not drive or operate machinery for a few hours after having this treatment, even if you feel okay.
Other side-effects:
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects
This chemotherapy can increase your skin’s sensitivity to the sun. It is best to avoid strong sunlight and wear a hat and use a sun block when in the sun.
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy
Contact telephone numbers
Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:
Pharmacy department 029 2061 5888 ext 6223
Monday-Friday 9am-5pm for queries about your medicines
Macmillan freephone Helpline 0808 808 0000
Tenovus freephone cancer helpline 0808 808 1010
This information is also available in Welsh
This leaflet was written by health professionals. The information is evidence based and has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.