ECF

This information sheet is offered as a guide to you and your family. Your treatment will be fully explained by your doctor or nurse, who will be happy to answer any questions. 

Treatment: Your doctor has prescribed for you a treatment known as ECF, which consists of the following chemotherapy drugs: - 

Epirubicin, Fluorouracil, Cisplatin 

Two of these drugs are administered in the form of an intravenous injection and infusion (via a ‘drip’ into a vein in your arm). You will be admitted to the unit every three weeks usually requiring an overnight stay. The third drug Fluorouracil (5FU) is administered continuously via a central venous catheter (long line). This drug is administered via a pump, a small plastic bottle, which will be attached to the end of your long line. You will be supplied with a holder in which your pump can be carried whilst you are undergoing treatment. You will be asked to attend the unit every week for renewal of your ‘pump’.
 
As each patient is an individual your experience will be different to other patients receiving chemotherapy. Common side effects that you may experience during treatment are: 

Nausea and vomiting (sickness) 
The severity of any nausea and vomiting will vary from person to person. An anti-sickness injection will be administered prior to your chemotherapy. You will also be given some antisickness tablets to take home. If you continue to feel sick, contact the day unit or your GP as your anti-sickness medication may need to be changed or increased. It is extremely important that you always drink 2 litres + of fluid per day to maintain healthy kidney function needed to continue your treatment. 

Sore Mouth
Following treatment your mouth may become sore and you may notice mouth ulcers. To prevent any mouth ulcers becoming infected you should use an anti-bacterial mouth wash; ask your doctor or nurse to recommend one that is suitable. 

Bone Marrow Suppression 
Your bone marrow is where your blood cells are made (these are the red cells, white cells, and platelets) to replace those naturally worn out by the body. Chemotherapy interferes with this process and the number of the cells in your blood can become lower than normal. This means following your treatment you could become.
 

• Prone to infection: White cells fight infection, a low white count can make you prone to infection. You may develop a sore throat, cough, high temperature, shivering or other symptoms, which may be due to infection. If you develop a high temperature, shivering or any symptoms, which may be due to an infection, immediately contact your GP or NCCT. 
  A raised temperature is: 
  Above 38C (100.4F) at any time 
  or Above 37.5C (99.5F) at any two readings, taken an hour or more apart.
   
•  Anaemia: Red cells carry oxygen around your body, a shortage of these cells is called anaemia. You may feel dizzy, out of breath or unusually tired and you may look pale. 
   
• Prone to bleeding: Platelets help to clot your blood and slow down bleeding. A low platelet count may make you prone to bleeding, this usually takes the form of nosebleeds, bruising or bleeding gums. You will have a routine blood test prior to each treatment to monitor the effects of the chemotherapy. Please contact your GP or the unit if you experience any of these symptoms. 

Hair loss 
Unfortunately as a result of this treatment you will experience hair loss which is temporary, your hair will grow back on completion of your treatment. (You may notice some hair loss approximately 2-3 weeks from the start of your treatment). Your nurse will arrange for you to be provided with a wig if required. Discoloured urine Your urine may become pink-red colour. This is due to the colour of the drug and may last up to 48hrs. This is quite normal and is not a cause for concern. 

Tingling or numbness in fingers or toes 
Occasionally, loss of feeling, tingling and numbness of the hands and feet may occur, this is usually temporary. If you experience any of these symptoms please report them to your nurse or doctor. 

Hand - Foot Syndrome 
You may experience some changes in your nails and skin during treatment. Your skin may become quite dry when having treatment over a prolonged period of time. Skin on hands and feet can become red and tender. Occasionally blistering and numbness can occur. Please mention any of these symptoms to your doctor or nurse. 

Fluid Intake
Cisplatin can cause kidney damage if fluid intake is poor. It is very important that you drink a minimum of 2 litres each day every day when you are at home in between treatments. If nausea or vomiting prevents you doing this must inform your doctor or your ward as soon as possible. 

Changes in hearing
Tinnitus (ringing in the ears) may occur and some high tone hearing loss may occur. This may or may not subside when treatment ends, please inform us if this occurs. 

Extravasation
The drugs you are about to receive are known as “ cytotoxic “ or “chemotherapy” drugs. Very few of these drugs may be given by mouth and most need to be administered directly into the blood stream through a plastic needle inserted directly into a vein, this needle is known as a cannula. It is therefore very important that good venous access is found (a good vein in which to put the cannula) so that chemotherapy may be given directly into a vein. It should not cause pain on administration and often the only sensation you may experience is a “coldness “ running up your arm. If the drip had displaced itself from the vein an “extravasation” could occur where chemotherapy is administered outside the vein, causing damage to the surrounding tissues. This happens very rarely. Indications are pain around the cannula site, redness or swelling. Your nurse will of course be looking for any signs of extravasation throughout the time your chemotherapy is in progress but it is essential that you inform your nurse if problems arise. Very occasionally patients may notice pain and discomfort around the area only after their chemotherapy has been completed. This also must be reported immediately so that appropriate treatment may be prescribed.
 
Fatigue 
Many people feel tired and have low energy levels whilst undergoing chemotherapy. There is very little you can do to avoid this but research has shown that patients who suffer fatigue need to take gentle exercise and rest often. This feeling of fatigue is quite normal and energy levels will begin to improve once treatment is completed. 

Please remember side effects are usually temporary. If you experience any of them, discuss them with your doctor or nurse. 

If you have any questions or concerns regarding your treatment please contact:

Mon-Thurs 8.00am - 6.00pm             Day Unit ward 36 tel. 0191 2563536/2563682 
Friday 8.00am - 4.30pm 

Outside these hours                           Wards 37/38 tel. 0191 2563537/2563538 

N.B. If you require further information regarding the drugs you receive British Association of Cancer United Patients and their Families and Friends (BACUP) produce an in formation booklet free of charge. The telephone number is Freephone 0808 800 1234.

Information Produced by N.C.C.T. 
May 2002, Reviewed June 2003
Review Date June 2005