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Dose dense AC-Paclitaxel
chemotherapy guide
For patients with breast cancer
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Table of contents
How does it work? ............................................. 4
What should I discuss with my doctor before
starting chemotherapy? ..................................... 5
What is dose dense AC-Paclitaxel? ................... 9
What is the treatment schedule? ........................ 9
How should I prepare for treatment? ................ 10
What can I expect during my treatment? .......... 11
What are the common side effects of dose dense
AC-Paclitaxel treatment? ................................. 13
How do I manage common side effects? ......... 15
Where can I get support? ................................. 33
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Your health care team
Oncologist:
_______________________________
Pharmacist:
_______________________________
Nurse:
_______________________________
Dietitian:
_______________________________
Social worker:
___________________________________
Medical Day Care: 416-864-5222
2 Donnelly Nursing Unit: 416-864-5099
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What is chemotherapy?
Chemotherapy is a type of treatment for cancer.
Chemotherapy can be a single drug or it can be a few
types of drugs at the same time. When used alone or
along with surgery or radiation therapy, chemotherapy
can often shrink a tumour or prevent its spread.
How does it work?
Chemotherapy kills cells that grow quickly. This is
why it kills cancer cells. But it also affects healthy
cells that grow fast. This includes cells in the mouth
and stomach lining, bone marrow, skin and hair. This
is why patients having chemotherapy treatment get
side effects such as hair loss, nausea and low blood
cell counts.
As a rule, chemotherapy is given in cycles of
treatment. There is a time of no treatment between
cycles. This lets normal cells recover before the next
cycle begins.
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What should I discuss with my doctor before starting chemotherapy?
Your health history
• Tell your oncologist (cancer doctor) about any
other health problems you have or had. Some
health problems may affect the outcomes with
this treatment.
• Tell other healthcare professionals you are
seeing about the type of chemotherapy you are
having.
Vaccines, surgery, dental work
• You should have all your dental work done
before you start your treatment.
• Check with your oncologist before you have
any vaccines, surgery or dental treatment.
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Other medicines, herbs and supplements
• Tell your oncologist, chemotherapy nurse,
dietitian and pharmacist about any over the
counter, herbal or doctor-prescribed medicines,
including vitamins, you are taking.
• Check with your oncologist, chemotherapy
nurse, dietitian or pharmacist before you start
taking any new drugs, including vitamins,
herbal or alternative treatments.
• Tell your oncologist if you are taking ASA
(Aspirin®), ibuprofen (Advil® or Motrin®),
acetaminophen (Tylenol®), naproxen (Aleve®)
or blood thinners.
Heart Test
• You will have a heart test before starting
chemotherapy. This is to be sure that your heart
is working properly.
• Adriamycin (the A in AC-P) can only be used if
you have normal heart function.
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Birth control
• Women who have not yet reached menopause
should take steps to avoid getting pregnant
while being treated. Chemotherapy may harm
your baby.
• Talk to your oncologist about what kind of birth
control you can use to make sure you do not
become pregnant.
Pregnancy and fertility
• If you want to have children, speak to your
oncologist before starting your first treatment.
Chemotherapy may affect your chances of
having a baby in the future.
• Tell your oncologist as soon as possible if you
become pregnant.
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Breastfeeding
• If you have a baby, do not breastfeed while
being treated with chemotherapy. Ask your
oncologist how long you should wait to
breastfeed after your final chemotherapy
treatment.
Your menstrual cycles (periods)
• Your periods may become heavier or lighter.
This change could be permanent.
• You may develop symptoms of menopause
such as hot flashes, vaginal dryness, mood
swings and changes in sexual desire. Talk to
your doctor if any of these symptoms bother
you.
Ask your chemotherapy nurse, pharmacist or
oncologist if you have any questions.
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What is dose dense AC-Paclitaxel?
Dose dense AC-Paclitaxel is the name of a
combination of drugs used together to treat breast
cancer. The names of the drugs are Adriamycin®,
cyclophosphamide and paclitaxel. These drugs are
liquids. They are given through a needle in your arm.
What is the treatment schedule?
Each AC-Paclitaxel cycle is 2 weeks long. This
means you will be considered for treatment once
every 2 weeks.
For the first 4 cycles of your treatment (cycles 1 to 4)
you will receive Adriamycin® and cyclophosphamide
(AC).
For the last 4 cycles of your treatment (cycles 5 to 8)
you will receive paclitaxel (PACL).
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How should I prepare for treatment?
Before starting each AC treatment (cycles 1 to 4),
drink plenty of fluids and urinate often. AC can cause
bladder irritations.
Tell your oncologist or chemotherapy nurse if:
It is painful to urinate (pee)
There is blood in your urine
Before your treatments with paclitaxel, your doctor
will give you a prescription for dexamethasone tablets
to help prevent some of the side effects of the
chemotherapy. Take your dexamethasone tablets the
night before your chemotherapy treatments. Your
doctor and pharmacist will give you more instructions
on how to take this medicine.
While being treated, do not eat grapefruit, pomelo
(Chinese white grapefruit), starfruit, Seville orange
and the juices and products made from them. They
may increase your side effects or change how
effective the treatment is.
Other that that, most patients can eat and drink as
normal. Your oncologist will tell you if you need to
change what you eat.
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What can I expect during my treatment?
On the day of your treatments you will come to the
Medical Day Care Unit:
1. You will have a blood test before each
treatment to check your blood counts. Low
blood counts can mean your body won’t be able
to handle another dose chemotherapy and your
treatment may be delayed.
2. In the Medical Day Care Unit a chemotherapy
nurse will give you AC or paclitaxel through a
needle in your arm.
3. AC treatment: Tell your chemotherapy nurse
right away if you feel any burning or pain when
you are having AC treatment. Some
chemotherapy drugs can damage your skin if
they leak out.
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4. Paclitaxel (PACL) treatment: Tell your
chemotherapy nurse if, during your treatment,
you:
Feel short of breath
Have pains in your chest
Notice itching, swelling, or a severe rash
Have fever or chills
These are signs that you might be allergic to
paclitaxel. If you have these symptoms after
you leave the Medical Day Care Unit, go to the
emergency department right away.
5. Once your treatment is done, you can go home.
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What are the common side effects of dose dense AC-Paclitaxel treatment?
Side effects of chemotherapy depend on the types of
drugs used and how your body reacts to those drugs.
Side effects of Adriamycin and cyclophosphamide
treatment (cycles 1 to 4)
Nausea (sickness in stomach) and vomiting
Infection (fever, chills, cough, sore throat)
Sores in your Mouth
Fatigue (tiredness and weakness)
Red urine
Troubles with memory or concentration
Hair loss
Bowel changes: constipation and diarrhea
Pain with urination
Irritated and watery eyes
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Side effects of paclitaxel (PACL) treatment (cycles
5 to 8)
Numbness or tingling in the hands or feet
Hair thinning
Pain in the muscles or joints
Diarrhea
Mild swelling in arms and legs (puffiness)
Sores in your mouth
Fatigue (tiredness and weakness)
Infection (fever, chills, cough, sore throat)
Bleeding, bruising or red spots on skin
Dry or itchy skin
Mild nausea (sickness in stomach) and vomiting
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How do I manage common side effects?
Nausea and vomiting
Nausea and vomiting is normal with AC treatment. It
is worse during the first 12 to 48 hours after treatment.
It often gets better in 3 to 7 days.
You will be given a prescription for medicine to take
before your chemotherapy treatment to prevent nausea
and vomiting. You will also get a prescription for
medicines to take if you have nausea and vomiting
even though you already took the prevention
medicine. This is called rescue medicine. Your
pharmacist will explain these drugs to you.
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What you can do
• Try to take your rescue medicine for nausea and
vomiting as soon as you start to feel nauseated
or 30 minutes before a certain time you think
you will have nausea and vomiting (for example
before dinner).
• If you vomit within 30 minutes of taking your
anti-nausea pills or see a pill come up, you can
take another pill.
• Drink lots of liquids.
• Get fresh air and plenty of rest.
• Eat small frequent meals and limit spicy, strong
smelling foods.
When to get help
If you vomit for more than 24 hours or feel nausea
longer than 48 hours, even though you are taking your
nausea medicine, contact your oncologist or
chemotherapy nurse.
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Infection
The risk of infection is highest 7 to 10 days after each
chemotherapy treatment. The number of white blood
cells that fight infection will be lowered with each
chemotherapy treatment. This means it will be easier
for you to get sick.
Signs of infection
Severe cough, sore throat
Chills
Fever
Burning when urinating (peeing) or urinating
too often
Open wound that appears red or swollen
What you can do
• Keep a thermometer at home. Take your
temperature when you are not feeling well.
• Limit contact with people who are sick or
have colds.
• Wash your hands often to lower your chances
of getting sick.
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When to get help
Go to the nearest emergency department right away if
• Your temperature is above 38º Celsius or
100.4º Fahrenheit for more than 1 hour
or
• You have a temperature higher than
38.3º Celsius or 100.9º Fahrenheit
Tell the emergency department that you are receiving
chemotherapy treatment.
Do not take any medicines such as acetaminophen
(Tylenol®), ibuprofen (Advil® or Motrin®) or ASA
(Aspirin®) until you have seen a doctor.
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Bruising, bleeding or red spots on skin
Chemotherapy can cause you to have a low platelet
count. Platelets help form blood clots so you will stop
bleeding if you are cut or bruised. This means you
could bleed more easily when you are receiving
chemotherapy.
Do not take ASA (Aspirin®), ibuprofen (Advil® or
Motrin®) or new medicines (herbal or traditional)
without speaking to your doctor first.
If your stools are black or bloody stools, you may
bleeding from your stomach, intestines or colon.
What you can do
• To avoid harming your skin, be careful when
you use sharp objects.
• Use a soft toothbrush to avoid bleeding or
bruising in your mouth.
• Tell your doctor before having any dental
treatment.
When to get help
Go to the nearest emergency department if you have
bleeding or bruising that is unusual or will not stop.
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Hair thinning
Hair thinning usually starts 2 to 3 weeks after your
first treatment. Your scalp may feel tingly as your hair
is falling out.
What you can do
• Use a gentle shampoo and a soft hair brush.
• Avoid using dyes, perms, bleaches and hair
sprays until 6 months after your last
chemotherapy treatment.
• Protect your scalp from sun exposure and
cold weather.
• Consider cutting your hair short before it
falls out.
• Ask your chemotherapy nurse for information
about wigs and head coverings.
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Tiredness and weakness
Feeling tired and weak is most common after the first
7 days of each cycle. You may feel more and more
tired with each treatment. It takes a few months for the
tiredness to go away even after your treatment has
ended. Your energy level will improve over time.
A low red blood cell level can also make you tired.
When your oncologist does blood work they will
monitor your red blood cells.
What you can do
Eat well-balanced meals.
Do mild exercise such as walking.
Be sure to rest well when you need to.
Call your doctor or nurse if you
Have shortness of breath
Fall and hurt yourself
Feel dizzy when you walk or when you
get up out of bed
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Mild swelling in arms and legs (puffiness)
What you can do
• Your doctor may prescribe some medicines to
prevent swelling.
• Keep your feet up while in bed and when you
are sitting.
• Try to eat a low-salt diet.
When to get help
Contact your oncologist or nurse as soon as possible if
swelling is severe or does not improve.
Go the the emergency department right away if you
have:
Severe swelling in your arms and legs
and
Trouble breathing
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Lip or mouth sores
You may notice lip or mouth sores a few days after
each treatment. They can last from a few days to
weeks. You might get sores on your tongue, gums,
lips, sides of the mouth or in your throat.
What you can do
• Keep your mouth clean. Brush your teeth and
tongue often and use a soft toothbrush.
• Rinse your mouth 3 times each day with
1 teaspoon of baking soda or salt in a glass of
water, soda water or mineral water.
• Avoid commercial mouthwashes with alcohol
in them, such as Listerine® and Scope®. They
will make mouth sores worse.
• Avoid hot, spicy and acidic foods like hot
peppers, tomato sauce, lemon juice and oranges.
• Tell your doctor if you are having trouble eating
or drinking.
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When to get help
If you develop a white film on your tongue, tell your
doctor. You may need medicines to treat it.
Call your doctor or nurse if you
Have trouble swallowing.
Cannot eat for more than 48 hours.
Are bleeding a lot from your mouth or gums
and it lasts for hours.
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Muscle and joint pain
You may have muscle and joint pain for a few days
after each treatment.
What you can do
• Take any medicines your doctor prescribed
for your pain.
• If your doctor did not give you painkillers you
can get acetaminophen (Tylenol®) over the
counter. Ask your doctor about the right dose
for you.
• Rest when you need to and try light exercise.
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Diarrhea (loose watery stools)
What you can do
• To treat diarrhea you may use loperamide
(Imodium®) or a stronger anti-diarrhea
medicine called Lomotil®. Your doctor may
have given you a prescription for these
medicines.
• If you buy loperamide (Imodium®) over the
counter, be sure to ask your doctor about the
right dose for you. The amount you should take
may be higher than the amount on the package.
• Drink lots of liquids. Choose water-based
drinks that include sugar and salt, such as sports
drinks, Jell-O and broth.
• Eat and drink small amounts often.
• Avoid high-fibre foods.
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When to get help
Go to the emergency department or contact your
oncologist if you have:
• Severe watery diarrhea (more than 5 times in a
day)
• Watery stools lasting longer than 24 hours,
despite taking loperamide (Imodium®) or
Lomotil®
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Constipation
You may be constipated if you have not had a bowel
movement (poo) for 2 days.
What you can do
• Eat a balanced diet high in fibre with lots of
fruits and vegetables.
• Try light exercise.
• Laxatives may help. Ask your oncologist,
chemotherapy nurse or pharmacist about the
right dose for you.
When to get help
If you try laxatives and still have not had a bowel
movement for 3 or more days, call your doctor or
chemotherapy nurse.
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Heartburn
What you can do
• Take your dexamethasone tablets with food.
• Try taking antacids such as Maalox® or Tums®
if you need relief from mild heartburn.
• If you have severe heartburn, tell your doctor at
your next visit. You may need a prescription
medicine.
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Numbness and tingling in hands and feet
Numbness and tingling may slowly return to normal
after your treatment ends.
What you can do
Contact your doctor if you have trouble
Doing up buttons
Writing
Picking up small objects
Or if you
Feel pain when you move
Have trouble moving
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Watery eyes
Your eyes may become irritated or watery during your
treatment. This can last up to a few weeks after your
treatment is done.
What you can do
• Avoid wearing contact lenses during your
treatment.
• Wear sunglasses when exposed to the sun.
Your eyes maybe more sensitive to the light.
• Use artificial tear eye drops to help moisten
your eyes.
• Try putting cucumber slices or cold tea bags on
each eyelid. This may help reduce soreness.
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Red urine
Red coloured urine is normal because of the colour of
the AC chemotherapy. The colour will go away 3 to 4
days after treatment.
What you can do
• Drink lots of liquids.
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Where can I get support?
Wellspring: A Lifeline to Cancer Support
Wellspring programs are open to individuals
diagnosed with any type of cancer and caregivers who
are coping at any stage in the cancer journey. Various
programs are available including individual and group
support, coping skills, expressive therapies,
educational workshops and presentations, and cancer
rehab programs. There is no cost for these services.
Wellspring Downtown Toronto (Office)
4 Charles Street East, Suite 300
Toronto, Ontario
M4Y 1T1
416-961-1928
Westerkirk House at Sunnybrook
105 Wellness Way
Toronto, Ontario
M4N 3M5
www.wellspring.ca
416-480-4440
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Gilda’s Club Greater Toronto
Gilda’s Club Greater Toronto provides support,
networking, educational and arts sessions.
Support groups are available for the entire family.
They are for parents, youth, children, cancer survivors
and individuals who are coping with the loss of
someone to cancer. Networking groups give
participants the opportunity to come together and
share different interests and experiences from their
unique situations.
Educational sessions help participants to learn new
skills and information in order to guide them through
their cancer journey. Arts programming encourages
personal expression, self reflection and participation
in arts events in Toronto.
Gilda’s Club Greater Toronto
24 Cecil Street
Toronto, Ontario
M5T 1N2
www.gildasclubtoronto.org
416-214-9898
35
Look Good, Feel Better
This program offers a free two-hour workshop for
women whose appearance has been affected by cancer
and cancer treatment. The workshop helps women
learn how to look and feel a little more like
themselves again. Guided by experts through the
Signature Steps, they master simple cosmetic
techniques, explore hair alternatives and learn about
cosmetic hygiene, nail and skin care. Participants take
home a complimentary kit of cosmetics and personal
care products that are generously donated by the
member companies of the Canadian Cosmetic Toiletry
and Fragrance Association.
Some workshop are hosted in hospitals. Please see the
following website for more information:
Look Good, Feel Better
www.lgfb.com
905-890-5161
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Cleaning for a Reason
Women undergoing treatment for any type of cancer
can receive professional house cleaning services. In
collaboration with Heart and Soul, Cleaning for a
Reason is a non-profit organization serving the United
States and Canada. Services include 4 free cleanings.
One cleaning per month.
Cleaning for a Reason
www.cleaningforareason.org
1-877-337-3348
Cottage Dreams
Cottage Dreams is a program to help families touched
by cancer enjoy time together at a private, donated
cottage. Families only pay a non-refundable
application fee of about $100 for a one-week getaway.
Please consult the website for more information. The
program is offered from June to December of every
year.
Cottage Dreams
www.cottagedreams.ca
705-457-9100
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Rethink Breast Cancer
Rethink Breast Cancer provides educational materials,
support and research for young women. A variety of
support programs are available, including for women
in their 20s and 30s.
Rethink Breast Cancer
www.rethinkbreastcancer.com
416-920-0980
Willow Breast Cancer Support Canada
Willow Breast Cancer Support Canada connects
participants with a breast cancer survivor to learn
first-hand experiences, a patient’s journey through the
stages of disease, treatment and recovery.
Willow Breast Cancer Support Canada
www.willow.org/en
416-778-5000
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Princess Margaret Hospital Lodge: Free new and
used wigs
If you are experiencing hair loss, you may wish to buy
a head covering. The Princess Margaret Hospital
Lodge provides free wigs for those who wish to use
one.
Princess Margaret Hospital Lodge
545 Jarvis Street, Room B-59
Toronto, Ontario
M4Y 2H7
416-413-7412
Nanny Angel Network
You can get professional childcare at no cost through
this network. Services are for mothers diagnosed with
breast cancer, in treatment or in the early stages of
recovery. Nanny Angel volunteers provide childcare
while mothers attend appointments or simply choose
to rest.
4841 Yonge St., Unit 2B
North York, Ontario
M2N 5X2
www.nannyangelnetwork.com
416-730-0025
39
Notes:
40
30 Bond Street, Toronto, ON M5B 1W8 Canada
416.864.6060 stmichaelshospital.com
73069 Rev. Feb26 2019 V2