Specialist Haematology Services

VAD


Introduction Show [+]Hide [-]

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 a treatment known as VAD you will be asked to attend the unit every three weeks for this treatment, for up to a maximum of six visits. The treatment consists of the following chemotherapy drugs: -

1. Vincristine infusion
2. Doxorubicin infusion
3. Dexamethasone tablets.

The first two of these drugs are mixed together, as an intravenous infusion given via a portable pump which is attached to your Hickman line and given gradually over four days.

The dexamethasone is administered orally, that is by mouth, for four days. Your dexamethasone tablets should be taken with food as they may cause indigestion. They may also increase your appetite. It is better to take them earlier in the day, for example, with breakfast or lunch since they can make you feel more alert and prevent sleep. The dexamethasone tablets can alter your mood causing you to feel low, irritable or agitated. Please tell the doctor at your next clinic visit if this is a problem.

Common side effectsShow [+]Hide [-]

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 as your anti-sickness medication may need to be changed or increased.

• Sore Mouth
Following treatment you may develop a sore mouth and may notice mouth ulcers. Very hot spicy foods should be avoided. To help prevent oral infections brush your teeth regularly (at least twice a day) and drink plenty of fluids. 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. Occasionally during treatment you may experience a strange taste sometimes described as a metallic or bitter. A strong flavoured sweet or mint may help disguise this.

• 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 so a low white cell 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. A normal temperature is between 36°C and 37°C. A raised temperature is:

Above 38°C (100.4°) at any time or
Above 37.5°C (99.5°F) at any two readings taken an hour apart.
Please contact Ward 6B or 8 immediately if you develop any symptoms.

• Anaemic: 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 nose-bleeds, bruising or bleeding gums.
You will have a routine blood test prior to each treatment to monitor the effects of the chemotherapy. Please contact Ward 6B or Ward 8 if you experience any of these symptoms.

• Hair loss
Unfortunately as a result of your treatment you will experience hair loss. The hair falls out gradually 10 to 14 days following your first course of treatment. The time scale varies from person to person. Please remember that this is a temporary side effect and your hair will grow back when your treatment is completed. Your nurse will arrange for you to be provided with a wig if required. A scalp cooling service to prevent or reduce hair loss is available in this trust but is located at the Northern Centre for Cancer Treatment (NCCT).
If you wish to have further details please ask your nurse or doctor.

• Sex, pregnancy and family planning
If you are having chemotherapy it doesn’t mean that you shouldn’t have sex, but you may not feel like it. If there is a chance of pregnancy, you must use effective contraception while on chemotherapy. If you suspect that you or your partner may be pregnant please tell your doctor immediately. Chemotherapy may affect your ability to have children in the future – please discuss this with your doctor or chemotherapy nurse before treatment.

• 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.

• Tingling or numbness in fingers and toes
Occasionally, loss of feeling, tingling and numbness of the hands and feet may occur. This is usually temporary and may decrease over several months when your treatment is completed. If you experience any of these symptoms please report them to your doctor or nurse.

• Discoloured urine.
Because of its red colour, doxorubicin may discolour your urine red or pink for the first few times following treatment. This is perfectly normal and nothing to worry about.

• Constipation
Try to drink plenty of fluids and eat foods high in fibre such as fruits and cereals. Report this to your hospital doctor who may prescribe a suitable laxative.

• Heart damage
Adriamycin (Doxorubicin) may be harmful to your heart. However there is an established safe maximum dose and your treatment will stay well within this. As a precaution your doctor may arrange for you to have an ECG (heart tracing) or other tests to check your heart before your treatment.

• Nail ridging
The chemotherapy can cause your fingernails to develop ridges. This is temporary and the ridging will grow out.

• Extravasation
The drugs you are about to receive are known as “cytotoxic “ or “chemotherapy” drugs. Most of these drugs need to be administered directly into the blood stream through a cannula (a plastic needle inserted directly into a vein.) In most cases it should not cause pain on administration and often the only sensation you may experience is a “coldness “ running up your arm. However if the drip becomes dislodged from the vein an “extravasation” could occur with chemotherapy leaking outside the vein, causing damage to the surrounding tissues. This happens very rarely. Indications of this are pain, redness or swelling around the cannula site. Your nurse will be looking for any signs of extravasation while 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.

After your TreatmentShow [+]Hide [-]

Please note that alcohol is best avoided for 48 hours after completing each course of treatment.

Contact numbers

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

Ward 6b Monday to Friday, 8am to 5pm Tel No. 0191 2824388 (Direct line)
Ward 8 Available at all times Tel No. 0191 2825008 (Direct line)

Further information.

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.
BACUP information can also be accessed via the internet at www.cancerbacup.org.

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