This leaflet provides information on a course of chemotherapy called ECF. It will explain what this is and when and how it will be given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on ECF 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.
What is ECF chemotherapy?
ECF chemotherapy consists of three drugs:
E = Epirubicin
C = Cisplatin
F = 5-Fluorouracil (5-FU)
When they are combined they are known as ECF for short.
Why am I having ECF chemotherapy?
Your doctor has recommended this chemotherapy because it has been found to be effective in treating your type of cancer.
Will I need any tests before I have my chemotherapy?
You will need a series of blood tests before you start your ECF chemotherapy. One of these blood tests helps us to check that your kidneys are working well enough to cope with the chemotherapy.
How will my chemotherapy be given?
To receive your chemotherapy you will need to have a fine tube put into a large vein in your upper arm. This tube is called a PICC line. Your PICC line is usually put in about a week before you start your chemotherapy. It will stay in for the whole course of your treatment. Your doctor will explain this to you in more detail.
We have a leaflet that tells you more about PICC lines. Please ask if you would like a copy.
How often will I have my chemotherapy?
For this treatment to be most effective it is given at specific time intervals. These are known as cycles.
The epirubicin and cisplatin are given through your PICC line once every three weeks for up to six cycles. Your doctor will discuss with you the exact number of cycles you receive.
The 5–FU part of your treatment is given continuously. The 5-FU is put into a bag which fits into a small portable pump.
How do I look after the portable pump?
We will explain all about the pump, how it works and how to look after it. We will also give you written information.
How often will I need to visit the hospital?
To receive ECF chemotherapy treatment you will need to visit the hospital four times in every three week cycle.
Outpatient clinic appointment – you will have blood samples taken 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. This appointment is usually a few days before your chemotherapy appointment.
Day 1 chemotherapy appointment – you will spend approximately seven hours on one of the day case treatment areas. Please allow an extra 30 minutes for your first visit. You will be given anti sickness medicine, fluids and your chemotherapy.
Day 8 chemotherapy appointment – on this visit your 5-FU pump will be changed. This visit should be no longer than an hour.
Day 15 chemotherapy appointment – on this visit you will need to have blood samples taken and your 5-FU pump changed. This visit may take 2-3 hours.
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 not usually room for more than one 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 with ECF chemotherapy. The doctors, nurses and pharmacy team can give you advice or answer any questions you may have.
Hair loss
Unfortunately ECF chemotherapy will cause complete hair loss. 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 have leaflets that tell you more about scalp cooling and coping with hair loss. Please ask your nurse if you would like a copy.
Sickness
Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective. If you are sick more than once in 24 hours despite taking regular anti-sickness medicine when you are at home after your chemotherapy treatment, then please contact Velindre Cancer Centre for advice. 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.
Diarrhoea
You may have diarrhoea with ECF chemotherapy. If this occurs it is important that you drink plenty of fluids. Medication is available to control diarrhoea. If you have four or more bowel movements in 24 hours above what is normal for you please contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
Tiredness and fatigue
Chemotherapy can make you feel more tired than usual. It is important to listen to your body and rest if you need to, but to carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as taking rest.
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 (telephone number is at the end of the leaflet).
Sore mouth
Your mouth may become sore or you may notice small ulcers. Please follow the advice on caring for your mouth in the general chemotherapy leaflet. Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.
Effect on your kidneys
Cisplatin can affect the way your kidneys work. The blood test which you have before your chemotherapy will check how well your kidneys are working at the start of treatment. We will also monitor you carefully by taking regular blood tests throughout your treatment.
We always give cisplatin with plenty of fluids in the drip to reduce the effect on your kidneys. It is also important that you drink plenty of fluids for at least two days after each treatment. We suggest a cup or glass of fluid every hour during the day and evening.
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 tell your doctor 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
Other side effects
Epirubicin may cause some heart problems. If you have a heart condition or you take any heart medication please tell your doctor before you start chemotherapy.
Epirubicin will harmlessly discolour your urine red for a day after your chemotherapy. If this lasts for more than 24 hours please contact Velindre Cancer Centre for advice.
Cisplatin may damage the nerves of your hands and feet. You may experience numbness or changes in sensation such as tingling or pins and needles. Although this is very rare it is important that you tell your doctor if this happens so that we can modify your treatment before this side effect becomes permanent.
Cisplatin may also damage the nerves responsible for hearing, although this is rare. If this occurs you may experience some loss of hearing which may be permanent.
Women sometimes find that chemotherapy treatment affects their periods. They could become heavier, lighter or even stop altogether.
It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.
ECF chemotherapy can increase your skin’s sensitivity to the sun. It is best to avoid strong sunlight, wear a hat and use a sun block.
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
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 0808 808 1010
cancer helpline
This information is also available in Welsh
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.