Etoposide & Ifosfamide

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.
 
Your treatment: your doctor has prescribed for you the following chemotherapy drugs: - 

1. Etoposide 
2. Ifosfamide 

Chemotherapy is administered via a ‘drip’ into a vein in your arm. Treatment usually entails a three to four night stay in hospital. You will be asked to attend the unit every three weeks for each cycle, up to a maximum of 6 cycles. 

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. 

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 mouthwash, 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 unusually tired, dizzy or out of breath 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. 

Infertility
The drugs used within your treatment can cause infertility. Your doctor will discuss this with you in detail. Despite this chemotherapy must not be considered a form of contraception; therefore normal precautions are still required.
 
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. 

Cystitis 
One of the drugs, Ifosfamide, may cause a side effect, which feels very like cystitis but is not due to infection. It can produce discomfort and burning when passing urine. A drug called Mesna is given as part of your treatment to stop this specific side effect. If, however symptoms do develop, please contact your doctor or nurse, as further Mesna tablets can be prescribed which may be taken at home. 

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 2563537/2563538 
Fri. 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 BACUP produce an information booklet free of charge. 
The telephone number is Freephone 0808 800 1234.

Information Produced by N.C.C.T. 
August 2002, Review Date: August 2003