Download Dear Breast Cancer Patient, You have recently had breast

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HUCH COMPREHENSIVE CANCER CENTER
Dear Breast Cancer Patient,
You have recently had breast cancer surgery. An oncologist has determined that
chemotherapy would significantly reduce the risk that your cancer will recur. You are
therefore about to start docetaxel and CEF adjuvant chemotherapy treatments.
The treatments are intravenous infusions to be administered at the outpatient clinic
every three weeks. Each infusion will last about two hours. There will be six
treatments in total. The first three treatments will contain the chemotherapeutic agent
docetaxel. The next three treatments will consist of CEF chemotherapy (a
combination of cyclophosphamide, epirubicin and 5-fluorouracil).
Docetaxel treatments cause side effects including hair loss (about two weeks after
the first treatment) and a decreased white blood cell count. White blood cell counts
will be at their lowest about one week after a treatment. While the count is low, you
will have a higher risk of infection. If you develop a fever of 38 degrees Celsius at
any time during the chemotherapy treatments, you should go to your regional
emergency clinic without a referral because you may need intravenous antibiotics.
You should also go to the emergency clinic if you can no longer manage at home
because of other symptoms that have weakened your condition.
If you are susceptible to infections due to other factors or diseases (such as
diabetes), your doctor may decide to add a growth factor (e.g. Zarzio or Neulasta) to
your chemotherapy regimen in order to counteract white blood cell reduction. Zarzio
is administered as subcutaneous injections for five days, Neulasta as a single
injection one day after chemotherapy treatment. Both may cause skeletal pain as a
side effect. You can make an appointment at your local health care center for the
injections, or you may be instructed on how to administer an injection yourself.
Docetaxel therapy can cause muscle and joint pain that goes away in a few days.
Regular painkillers are effective for this. Some patients develop mucous membrane
symptoms such as diarrhea, sensitivity of the oral membranes, temporarily
diminished sense of taste, or in some cases mucosal ulcers. Your nurse will give you
separate instructions for oral care at the time of treatment. You should remember to
eat and drink enough while undergoing the treatments, ingesting small amounts
frequently if necessary.
Some patients may notice changes in their fingernails or numbness and tingling in
their hands and feet as a result of docetaxel therapy. These symptoms are transient
and may be alleviated by wearing insulating gloves and socks during the treatments.
Docetaxel therapy can cause an allergic hypersensitivity reaction, so a three-day
course of corticosteroids will be added to the regimen (5 dexamethasone tablets of
1.5 mg in the mornings and evenings for three days, starting from the evening before
treatment). In spite of the corticosteroids, some patients develop symptoms
consistent with an allergic reaction when they receive the drug infusion. These may
include reddening of the facial skin and shortness of breath. If you feel anything
unusual, inform the nurse who is administering the treatment immediately.
Guideline: Information for breast cancer patients receiving adjuvant chemotherapy
31 Dec 2016
Custodian: Johanna Mattson Valid until
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HUCH COMPREHENSIVE CANCER CENTER
The corticosteroid may cause sleeplessness and stomach irritation, so a
gastrointestinal protectant is often added to the regimen. This medication reduces
the secretion of gastric acids. Patients who have a sensitive stomach may use it
continuously throughout the chemotherapy period of about five months.
Many patients feel quite tired on the third day after a treatment, when they stop
taking the corticosteroid. Most patients feel very well during the third week after a
treatment, which is the week before the next treatment.
Women usually stop menstruating during chemotherapy treatments. However, they
must continue to use contraception if they had menstrual periods before the
treatments began. Menstruation usually resumes in younger women once the entire
chemotherapy period has been completed, but may stop permanently in older
women, leading into menopause.
CEF treatments also cause hair loss and mucous membrane symptoms. CEF
therapy causes nausea as well, so each treatment is combined with intravenous or
oral medication to prevent nausea. The doctor will also prescribe anti-nausea
medications for you to take home. Metoclopramide (trade name Primperan) is an
essential drug for nausea prevention. If it is not effective enough, a setron (such as
Granisetron) should be added to your regimen. If this combination does not
sufficiently relieve your nausea, your doctor may prescribe other anti-nausea drugs
such as dexamethasone, Emend or Temesta as needed.
CEF treatments also cause a decreased white blood cell count, usually less
pronounced but longer-lasting than with docetaxel treatments. CEF therapy
temporarily stains urine red.
Herceptin treatments
If a tumor is positive for HER2 gene amplification, intravenous Herceptin is added to
the chemotherapy. This can cause flu-like symptoms, such as cold chills, during
infusion. The first treatment session with chemotherapy takes about six hours
because you will be observed for another three hours after the drug infusion ends.
At your first visit, the attending physician will prepare a medical statement B for
special reimbursement of breast cancer drugs (leukocyte growth factor, hormone
treatments, some pain medications). The medical statement B will be mailed to your
home. You will then need to submit it immediately to the KELA (Social Insurance
Institution of Finland) office in your area.
At your first visit, you will receive at least the following drug prescriptions:
- Dexametason (dexamethasone) 1.5 mg (dosage 5 tablets twice daily for three
days), to be used in conjunction with Doketakseli (docetaxel) to prevent allergic
reactions
- Gastrointestinal protectants (such as Somac, Zolt, etc.) to be used along with
dexamethasone by those with sensitive stomachs
Guideline: Information for breast cancer patients receiving adjuvant chemotherapy Custodian: Johanna Mattson Valid until
31 Dec 2016
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HUCH COMPREHENSIVE CANCER CENTER
- Anti-nausea medication (Primperan and Granisetron or another setron drug), of
which Primperan should preferably be available at home even before treatments
start, setron only if it becomes necessary.
You will also receive a payment voucher for a wig. The wig is provided to the
recipient free of charge as an assistive medical device. The suppliers used by the
Hospital District of Helsinki and Uusimaa are Veijo Kinnunen Oy and Kuopion
kähärätarvike Ky/Kampaamo Jaana Kankkunen. They have a versatile and highquality (monofilament) selection. Both suppliers would like you to make an
appointment for wig selection and instruction.
Veijo Kinnunen Oy
Kartanonherrantie 2 a, 02920 Espoo, tel. 010 680 1000
Pohjoinen Rautatienkatu 19, 00100 Helsinki, tel. 010 680 1030
Kuopion Käherrystarvike Ky/Kampaamo Jaana Kankkunen
Topeliuksenkatu 33, 00270 Helsinki, tel. 09 2414 705
Before you start chemotherapy treatments, we recommend visiting a dentist who will
check the condition of your teeth and treat any pockets of infection.
Cancer patients are advised to get a seasonal flu vaccination during the flu season.
Please consult your nurse or doctor to determine the appropriate timing for this.
Your doctor may prescribe sick leave for you for the duration of the chemotherapy
treatments. This could be for a few days or the entire treatment period depending on
the type of work you do, the chemotherapy side effects and how you are feeling.
Driving a car immediately after treatment on a treatment day is not recommended,
and a nurse will give you a taxi voucher for your trip home if needed.
The nurse assigned to you is
and
can best be reached by phone on weekdays
from 8:30 a.m. to 9:00 a.m. and from 1:30 p.m. to 2:30 p.m.
at ____________________________
Guideline: Information for breast cancer patients receiving adjuvant chemotherapy Custodian: Johanna Mattson Valid until
31 Dec 2016