- Cyclophosphamide

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Cyclophosphamide

Introduction

Cyclophosphamide is chemotherapy that is given as a treatment for some types of cancer. This factsheet describes cyclophosphamide, how it is given and some of its possible side effects. It should ideally be read with CancerBACUP's booklet Understanding chemotherapy, which gives more information and advice.

Each person's reaction to chemotherapy is unique. Some people have very few side effects, while others may experience more. The side effects described in this factsheet will not affect everyone who is given cyclophosphamide, and may be different if you are having more than one chemotherapy drug. We have outlined the commonest and less common side effects, so you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed on the factsheet, please discuss these with your doctor or chemotherapy nurse. You will see your doctor regularly while you have this treatment so that s/he can monitor the effects of the chemotherapy. This factsheet should help you to discuss any queries about your treatment and its side effects with your doctor or chemotherapy nurse, as they are in the best position to help and advise you. What it looks like

A clear fluid after being dissolved from powder. It is available in pink tablets of 25mg and 50mg. How it is given As an injection into the vein (intravenously) through a cannula (a fine tube inserted into the vein).It may be given through a central line which is inserted under the skin into a vein near the collarbone. By drip (intravenous infusion) through a cannula. By mouth. The tablets should be swallowed whole with plenty of water. Possible side effects Temporary reduction in bone marrow function. This can result in anaemia, risk of bruising or bleeding, and infection. This effect can begin 7 days after the treatment has been given and usually reaches its lowest point at 10-14 days after the chemotherapy. Your blood count will then increase steadily and will have usually returned to normal within 21 days. The extent to which your blood count is reduced depends on the dose of chemotherapy you receive and which other chemotherapy drugs, if any, are given in combination. Your doctor can advise you how likely it is that your blood count will be lowered by the chemotherapy. Your blood count will be checked regularly to see how well your bone marrow is working. If your temperature goes above 38øC (100.5øF), or you have any unexplained bruising or bleeding, or you suddenly feel unwell, even if you have a normal temperature, contact your doctor or the hospital straightaway. Nausea and vomiting. There are now very effective anti-sickness drugs to prevent or substantially reduce nausea and vomiting. If it does happen it may begin a couple of hours after the treatment is given and last for up to 24 hours. If the sickness is not controlled, or continues, tell your doctor. S/he can prescribe other anti-sickness drugs which may be more effective. Loss of appetite. A dietitian or specialist nurse at your hospital can give advice. CancerBACUP has a booklet called Diet and the cancer patient which has tips on boosting appetite, coping with eating difficulties and maintaining weight. We would be pleased to send this to you. Irritation of the bladder. It is important to drink plenty of fluids to help prevent any irritation. If you notice any blood in your urine tell your doctor. Fertility. Your ability to conceive or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception. It is not advisable to become pregnant or father a child while taking cyclophosphamide as it may harm the developing foetus. Again, discuss this with your doctor. Hair loss. This usually starts 3-4 weeks after the first dose of cyclophosphamide, although it may occur earlier. Hair may be lost completely or may just thin. You may also experience thinning and loss of eyelashes, eyebrows and other body hair. This is temporary: the hair will return to normal once the treatment is finished. CancerBACUP has a booklet called Coping with hair loss. Less common side effects

Your liver may be temporarily affected. Cyclophosphamide may cause changes in liver function, which return to normal when the treatment is finished. This is very unlikely to cause you any harm, but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to monitor your liver function. Mouth sores and ulcers. If your mouth becomes sore or you notice small ulcers, tell your doctor. S/he can prescribe appropriate mouth care for you. Diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or persistent. It is important to drink plenty of fluids if you do have diarrhoea. Changes in nails. Your nails may become darker, or ridged. These changes grow out over a few months once the treatment has finished. Skin changes. Your skin may darken, due to excess production of pigment. Changes to the lungs. Cyclophosphamide may cause some changes to lung tissue. Tell your doctor if you notice any cough or shortness of breath. Second cancer. With long term use of this drug there is a very small risk of developing a second cancer after many years. Changes in the way your heart works. This is very uncommon with usual doses but may occasionally occur with high dose treatment. The muscle of the heart may be affected, usually temporarily. Tests to see how well your heart is working may be carried out before the drug is given, and occasionally before each treatment.

Additional information

Some people experience hot flushes, dizziness, a strange taste and a feeling of having a blocked nose when the drug is being given. If you have any of these symptoms tell the doctor or nurse. S/he can slow the drip down to reduce the feeling. This drug may be prescribed for conditions other than cancer. The drug dosage will then be much reduced and therefore these side effects will probably not occur. Some medicines can be harmful when you are having chemotherapy. Always tell your doctor about any medicine you are taking.

Not all chemotherapy drugs cause the same side effects, and some people may have very few. Cancer treatments produce different reactions in different people and any reaction can vary from treatment to treatment. It may be helpful to remember that almost all side effects are only short term and will gradually disappear once the treatment has stopped.

The main areas of your body that may be affected by chemotherapy are those where normal cells rapidly divide and grow, such as your mouth, digestive system, skin, hair and bone marrow (the spongy material that fills the bones and produces new blood cells). If you want to know more about side effects which may be caused by your chemotherapy treatment you should ask your doctor, as he or she will know the exact drugs you are taking. Although the side effects of chemotherapy can be unpleasant, they must be weighed against the benefits of the treatment. If, however, you are finding the treatment or its side effects are making you unwell, do tell your doctor, who may be able to give you medicines to help, or make changes to your treatment to lessen any side effects

Some people feel very tired during chemotherapy. This is quite normal and may be caused by the drugs themselves and your body fighting the disease, or simply because you are not sleeping well. For someone who normally has a lot of energy, feeling tired all the time can be very frustrating and difficult to cope with. The hardest time may be towards the end of the course of chemotherapy. Try to restrict any unnecessary activities and ask your family or friends to help you with chores, such as shopping and housework. Don't fight your tiredness. Give yourself time to rest and if you are still working see if it is possible to reduce your hours while you are having your treatment. If you are having problems sleeping, your GP may be able to prescribe some mild sleeping tablets for you. Some intravenous chemotherapy can be given to you as a day patient at the hospital, but if you do have to spend time in hospital, you may need to make more changes to your usual routines. Most employers will be sympathetic if you explain why you need time off work. If you are unable to work, your employer will pay your first 28 weeks' sick pay. If, after this period, you are still unable to work you can claim the short-term higher rate of Incapacity Benefit from the Benefits Agency. If you are unemployed and not fit to work you will need to switch from Unemployment Benefit to the short-term lower rate of Incapacity Benefit. To do this you should contact your local DSS office and arrange for a medical certificate from your doctor to cover the period of your illness. The Benefits Agency has a form (IB202) which outlines all these benefits and others you may be entitled to. Your local Citizens' Advice Bureau can also give useful information and advice on available benefits. During intravenous chemotherapy you may find you cannot do some of the things you used to take for granted. But you needn't abandon your social life completely. Depending on how well you feel, there is no reason to stop going out or visiting friends, especially if you can plan ahead for social occasions. For example, if you are going out for the evening, you could make sure you get plenty of rest during the day so you have more energy for the evening. If you are planning to go out for a meal, you may find it helpful to take anti-sickness tablets before you go and to choose your food carefully from the menu. For most people, having the occasional alcoholic drink will not affect their chemotherapy treatment, but you should check with your doctor beforehand. If you are going abroad on holiday, it is important to remember that you should not have any `live virus' vaccines while you are having chemotherapy. These include polio, measles, rubella (German measles), MMR (the new triple vaccine for measles, mumps and rubella), BCG (tuberculosis), yellow fever and oral typhoid. There are, however, vaccines which you can have, if necessary, while you are having chemotherapy. You should ask your doctor about whether you should have other vaccines such as diphtheria, tetanus, flu, hepatitis B, hepatitis A, rabies, cholera and typhoid injection.

Will my emotions be affected?

Many people find that having cancer, needing chemotherapy treatment and the effect that both of these may have on their lives can sometimes make them feel anxious, afraid or depressed. Often these feelings can be prompted by something seemingly trivial, such as having to change your usual daily routine to fit in with the treatments, or something more obvious, such as the side effects of the treatment, or the risk of infertility. If you do feel low or worried, for whatever reason, it is important to know that you are not alone. You can be sure many cancer patients have felt as you do at some time during their treatment and that, like them, you can overcome feeling fearful or discouraged.

One of the first steps to solving problems successfully is to find out exactly what is causing the problem in the first place. You may be feeling anxious for example, asking yourself questions like; `are the drugs working?', `what effects are they going to have on my body or long term health?', `how am I going to cope with the side effects?' Depression can set in as the drugs start to work on the cancer. Side effects, especially hair loss and tiredness which are caused by some of the drugs, can make you feel less happy about your appearance. Having to change your normal routine to make time for the treatments can also be upsetting. Sometimes, if the cancer is taking time to respond to the drugs, you can start to become discouraged and feel depressed. The greatest fear of all is fear of the unknown. Many cancer patients feel afraid of the future and what it might bring. Some also do not understand what is happening to their bodies and are frightened of the possible effects of the disease or the treatment