This leaflet provides information on a course of chemotherapy called EOX. The leaflet 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 EOX 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 EOX chemotherapy?
EOX chemotherapy consists of three drugs:
E = Epirubicin
O = Oxaliplatin
X = Capecitabine (also known as Xeloda)
When they are combined they are known as EOX for short.
Why am I having EOX chemotherapy?
Your doctor has recommended EOX 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 chemotherapy. One of these blood tests helps us to check that your kidneys are working well enough to cope with the chemotherapy.
How often will I receive my chemotherapy?
For this treatment to be most effective it is given at specific time intervals. These are known as cycles. It is usual to have EOX every three weeks for six to eight cycles. Your doctor will discuss the exact number of cycles you will have.
How will my chemotherapy be given?
Epirubicin and oxaliplatin are given through a drip into a vein in the back of your hand or arm. Alternatively it may be suggested that a fine tube called a PICC is inserted into a large vein in your upper arm. This will remain in place throughout the course of your treatment. Your doctor or nurse will discuss this further with you.
We have a leaflet that tells you more about PICC lines. Please ask if you would like a copy.
Capecitabine is given as tablets. The capecitabine tablets are taken twice a day for the whole course of treatment.
How often will I need to visit the hospital?
To receive EOX chemotherapy you will need to visit the hospital twice 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.
Chemotherapy appointment – you will spend approximately three hours in one of the day case treatment areas. Please allow up to an hour longer for your first visit. We will give you anti sickness medication then your epirubicin and oxaliplatin chemotherapy.
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.
How should I take the capecitabine tablets?
Capecitabine tablets should be taken twice a day (9-12 hours apart), You should take the tablets within 30 minutes of finishing your meal. The tablets should be swallowed whole with a glass of water. They must not be chewed or crushed.
It is important that you wash your hands thoroughly after taking your tablets.
How many tablets will I need to take?
This varies for each person. There are 2 different strength tablets which are different sizes. The big tablets are 500mg and the small tablets are 150mg. You may have to take a combination of big and small tablets. The amount you need to take will be clearly marked on the boxes. Remember to check each box to see how many tablets you need to take.
What should I do if I forget to take my tablets?
Do not take the extra tablets when your treatment should have finished. It is important that even if you have missed any doses you should finish the treatment at the planned time.
What if I take too many tablets?
Please contact Velindre Cancer Centre immediately for advice. The telephone number is at the end of the leaflet.
How should I store my capecitabine tablets?
Store your tablets in their original packaging in a safe place away from children. They should be kept in a cool dry place (below 30oC).
Any unused tablets should be returned to the hospital Pharmacy or your local chemist for safe disposal.
What are the possible side effects?
There are a number of possible side effects which can occur. The doctors, nurses and pharmacy team can give you advice or answer any questions you may have.
Hair loss
Unfortunately you will lose your hair with this chemotherapy. This is only temporary. Your hair will grow back when your treatment has finished. A method known as ‘scalp cooling’ or ‘cold capping’ can sometimes be used to prevent hair loss. We can arrange a wig if you would like one. If you would like more information about scalp cooling or wigs please speak to your nurse.
We have a leaflet that tells you more on 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, stop taking your capecitabine tablets and 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. If this occurs it is important that you drink plenty of fluids. We will give you medication to take if you get diarrhoea.
You should stop taking your capecitabine tablets and contact Velindre Cancer Centre immediately if:
You should also contact us if you have any problems with diarrhoea or an increase in bowel movements which lasts for more than 3 days.
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 carry out your normal activities if you feel able. Some people find it beneficial to take gentle exercise as well as rest.
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.
If your mouth becomes very painful or you are finding it difficult to eat and drink, stop taking your capecitabine tablets and contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
Soreness to your hands and feet
You may experience mild pain, redness and swelling of your hands or feet. If this occurs we recommend using a non perfumed cream or lotion regularly. Please contact Velindre Cancer Centre if your hands or feet become painful. The telephone number is at the end of the leaflet.
Heart Problems
Very rarely some people having capecitabine chemotherapy experience heart problems. If you have a heart condition or you take any heart medication, please tell your doctor before you start chemotherapy. If you do have any chest pain you should stop taking your capecitabine tablets and seek urgent medical attention. Do not start taking your capecitabine again until you have spoken to the team at Velindre.
Vein pain
You may experience discomfort along the vein when this chemotherapy is being given as a drip. This can be prevented by having a PICC line inserted. If you would like more information please speak to your nurse or doctor.
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.
Nerve damage in your hands and feet
Oxaliplatin may cause tingling or numbness in your fingers or toes. 85 – 95% of people experience this to some degree. This is often triggered by exposure to cold, for example when you open the fridge or hold a cold drink. You may find it difficult to do up buttons or pick up small objects.
This usually lasts for no more than 7 days in between treatments. If the tingling or numbness does not go away between treatments there is a risk that this may become permanent. It is important that if you have this problem and if it lasts longer than 7 days please tell us at your next clinic appointment.
Unpleasant feeling in your throat
Oxaliplatin causes an unpleasant sensation in the throat in a small number of patients. This may result in a feeling of tightness in the throat or not being able to catch your breath. This will occur at the time of treatment or within a few hours. It may be brought on by cold so avoid ice-cold drinks for 24 hours after treatment.
We recommend that you wait for 20-30 minutes after your treatment before leaving the hospital. You should not drive yourself home and in cold weather we recommend your friend or relative heat the car before you get into it.
Please tell your nurse if you experience this whilst having your treatment. If it occurs after you leave the hospital please contact Velindre Cancer Centre immediately. The telephone number is at the end of the leaflet.
If this happens, try to relax, breathe out through your mouth and in through your nose. Try to move to a warmer area and try a warm drink. This sensation should pass quickly. It is best to relax.
Allergic type reaction
A small number of patients experience an allergic type reaction. If this occurs you may feel hot or flushed, itchy, light-headed or generally unwell whilst receiving your oxaliplatin. This can be easily treated. Please tell your nurse immediately if you experience any of the above symptoms.
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 your doctor or nurse.
A small number of patients experience jaw stiffness in the first few days after the oxaliplatin. This usually only lasts for a few days. If this occurs please tell us at your next clinic visit.
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.
EOX 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 a team of doctors, nurses and patients. It is reviewed and updated every 2 years.
Reviewed November 2009