Patient Name: Patient guide to chemotherapy with radiotherapy for rectal cancer Chemotherapy This guide should only be given to patients who have been prescribed capecitabine chemotherapy in conjunction with radiotherapy for rectal cancer A guide for patients and carers
Contents Introduction...1 Useful contacts...1 What is chemo-radiotherapy?...2 Chemotherapy...2 Radiotherapy...3 What will my treatment consist of and how long will it last?...3 What are the main side-effects associated with my treatment?...6 Tiredness...6 Diarrhoea...6 Hand-foot syndrome...7 Feeling sick (nausea)...7 Being sick (vomiting)...8 Mouth ulcers (stomatitis)...8 Changes in your blood...8 Redness and soreness of skin...8 Discomfort around the back passage...9 Pain whilst passing urine...9 Chest Pain...9 Further information...11 Treatment Diary...12
1 Introduction This guide will enable you to understand more about your chemoradiotherapy and answer some commonly asked questions. It also contains a treatment diary to help you to remember to take your medication. You should use the diary section to keep a record of your experience or questions you may want to ask your specialist the next time you see them. By recording your experiences every day, you will help your doctor to adjust the dose of the chemotherapy so that the treatment is correct for you. Useful contacts Consultant Name: Nurse specialist Name: Pharmacist Name: Radiographer Name: Ext: Ext: Ext: Ext: Out of hours contact Clatterbridge Cancer Centre Hotline 0800 169 5555
2 What is chemo-radiotherapy? Chemo-radiotherapy is a combination of chemotherapy and radiotherapy. This treatment is usually given before or after surgery for rectal cancer. Chemo-radiotherapy given before surgery can shrink the tumour and make it easier to remove and also reduce the chance of the cancer coming back. If chemo-radiotherapy is given after surgery we hope that it will destroy any remaining cancer cells and thus reduce the chance of the cancer coming back. Chemotherapy Chemotherapy uses drugs that are designed to kill cancer cells but are less harmful to healthy tissues. The chemotherapy that you will receive as part of your chemo-radiotherapy is called capecitabine. is a tablet that is taken orally. This means that you can take your chemotherapy at home and you won t need any needles other than for regular blood tests. You will be asked to take your capecitabine tablets twice a day (morning and evening) from Monday to Friday for the five days of each week when you have radiotherapy. Do not take them on days when you are not having radiotherapy. Your nurse or doctor will let you know when you should stop taking the tablets.
3 Radiotherapy Radiotherapy is a method of treatment that uses carefully calculated and measured doses of radiation. It targets the part of the body where the cancer is/was. You will receive external beam radiotherapy which is delivered from a machine outside the body. Radiotherapy treatment is painless and only takes a few minutes. What will my treatment consist of and how long will it last? The radiotherapy treatments are usually given each weekday (Monday to Friday) with a rest at the weekend (unless instructed otherwise by your healthcare team if your radiotherapy is moved to a Saturday) and normally continue for 5 weeks. Each weekday (from Monday to Friday) you will attend the radiotherapy department to receive a dose of radiotherapy. In addition to this you will be asked to take your chemotherapy tablets on these days (Monday to Friday only) On weekdays (Monday to Friday) you will need to take your first dose of chemotherapy in the morning, and then have your radiotherapy session at the hospital, and then take another dose of chemotherapy in the evening. At the weekend (Saturday and Sunday), you will not have to attend the hospital to have your radiotherapy and therefore not need to take your chemotherapy tablets at the weekend.
4 Weekdays (Monday Friday): chemotherapy tablets (am) Ü radiotherapy session Ü chemotherapy tablets (pm) Weekends (Saturday Sunday): do not take any chemotherapy tablets (unless instructed by your healthcare team) Your doctor and pharmacist will tell you exactly how many capecitabine tablets you will need to take in the morning and in the evening Number of 500mg capecitabine tablets Number of 150mg capecitabine tablets Morning chemotherapy Radiotherapy session Evening chemotherapy Your capecitabine tablets should be taken within 30 minutes after a meal. Therefore, it may be best to plan to take your tablets after breakfast in the morning and again after your evening meal. The
5 tablets should be swallowed with water. If you have difficulty swallowing these tablets, please contact the pharmacist or triage service for advice. Do your best not to forget any of your chemotherapy doses. However, if you do miss a dose, it is very important that you do not take it at a different time. Never double up on your next dose. This may cause more side-effects and may interfere with your other treatment. Make a note in the diary of the day and time the dose was missed and let the doctor, nurse or pharmacist know at the next visit. Return the missed tablets to the pharmacy at the end of your treatment Checking Your Temperature We will ask you to monitor your temperature. If you take regular pain medications e.g. paracetamol for any reason, it is important that you check you temperature before taking them. Fertility We advise you not to become pregnant or to father a child during and for some time after your treatment. You should discuss methods of contraception with your partner and, if necessary, a nurse or doctor before starting treatment. If you have completed treatment and are considering having a child, please talk to your Oncologist first. If fertility is important to you, please discuss it in more detail with your doctor before starting treatment.
6 What are the main side-effects associated with my treatment? Both chemotherapy and radiotherapy can have side-effects. If you do experience any side-effects it is very important that you let your nurse or doctor know. At the back of this booklet there is a treatment diary where you can record your daily therapy and any side-effects you may experience. Some of the most common side-effects associated with radiotherapy and capecitabine treatment are listed below. For further information about these side-effects or any other reactions you are concerned about, please do not hesitate to contact a member of your healthcare team. Tiredness During your chemo-radiotherapy treatment you may find that you feel very tired. This is very common and may be made worse by having to travel for your treatment every day. Listen to your body, and if necessary, allow yourself extra time to rest. Diarrhoea You may experience diarrhoea (loose bowels). If it is severe, more than 4 to 6 times in 24 hours, please stop taking your capecitabine tablets and telephone the Triage Service for advice immediately. You may be told to not take any further capecitabine tablets until you can be seen by your Oncologist. You may be advised to start
7 taking loperamide tablets (anti-diarrhoea) which you may have already been given. If you have diarrhoea, you should drink plenty of fluid. Hand-foot syndrome This is a less common side-effect associated with your capecitabine chemotherapy. It is a reaction that usually occurs on the palms of the hands and soles of the feet (hence the name hand-foot syndrome). Hand-foot syndrome can make your hands and feet feel numb or tingle, you may get dry skin or redness and you may notice that they start to swell. If you notice any of these signs, stop taking your capecitabine tablets and contact the Triage Nurse for further advice. Feeling sick (nausea) Whilst receiving your therapy you may feel the need to be sick (without actually being sick). This in turn may result in a reduced appetite. It is important that you try to maintain a healthy diet. Some people find that by eating small amounts of food at regular intervals, they are able to keep the feelings of nausea under control. It is important that you try to eat something before taking your capecitabine tablets, even if this is a few biscuits or a slice of toast with a glass of milk.
8 Being sick (vomiting) Another less common side-effect of your treatment is actually being sick. If you vomit more than once in any 24-hour period you should contact the Triage Service who will be able to provide you with advice on controlling these symptoms. Again, it is important to try to eat regular, healthy meals to keep your energy levels high. Mouth ulcers (stomatitis) If you get any pain, redness, swelling or sores in or around your mouth you should contact the Triage Service for advice. Changes in your blood Your chemotherapy can sometimes affect your bone marrow, which produces different types of blood cells. If the number of blood cells in your body gets too low you may feel more tired and run down. You may also be more likely to get an infection or have a high temperature (fever). Therefore regular blood tests will be arranged for you. Report any signs of infection or fever to the Triage Service immediately. Redness and soreness of skin Some people may experience a skin reaction, similar to sunburn, whilst they are receiving radiotherapy. You may find that the skin in the treatment area becomes red, sore and itchy. Let your radiographer know if you have any redness or pain in the area being treated. They will be able to advise you on how to look
9 after the skin in that particular area. Unperfumed moisturising creams can be helpful. It is important to avoid exposing this area of skin to the suns rays as this can increase the skin reaction. Discomfort around the back passage The rectum (back passage) may become irritated due to your treatment. If this is likely you may be asked to change your diet to control symptoms. You may also notice some discharge or bleeding from the back passage. Let your nurse or radiographer know if you have any of these problems. Pain whilst passing urine Occasionally patients may experience inflammation of the bladder, known as cystitis. You may notice a burning sensation or discomfort when you pass urine and feel that you need to go to the toilet more often than usual. Increasing the amount of fluid that you drink may help to relieve these symptoms; however it is very important that you let your radiographer or nurse know that you are experiencing this. Chest Pain This is an uncommon side effect (less than 1 in 100 patients) but potentially serious side-effect. If you experience pain or tightness in your chest (usually in the centre of your chest), stop taking the capecitabine tablets and attend A&E as soon as possible.
10 Clatterbridge Cancer Centre Hotline 0800 169 5555 If you are unwell during or up to 8 weeks following your cancer treatment please call the Clatterbridge Cancer Centre Hotline. Your call will be answered by a dedicated nurse advisor. This line is available 24 hours a day, 7 days a week. Please call the Hotline if you have any queries, but it is particularly important if you are experiencing any of the following: Suddenly feel unwell A temperature greater than 37.5 C Any unexplained bruising or bleeding Diarrhoea for more than 24 hours Unrelieved shortness of breath Mouth ulcers that stop you eating or drinking
11 Further information If you have any further questions, please do not hesitate to contact your consultant, pharmacist or nurse. You may also find the following support groups useful for general information: Macmillan Cancer Support Tel: 0808 808 0000 www.macmillan.org.uk Bowel Cancer UK Tel: 0870 850 6050 (Bowel Cancer Advisory Service) Email: admin@bowelcanceruk.org.uk www.bowelcanceruk.org.uk Beating Bowel Cancer Tel: 0845 071 9301 Email: nurse@beatingbowelcancer.org www.beatingbowelcancer.org
12 Treatment Diary - Week 1 Monday Tuesday Wednesday
13 Thursday Friday Saturday Do not take any capecitabine tablets (unless otherwise instructed) Sunday Do not take any capecitabine tablets
14 Treatment Diary - Week 2 Monday Tuesday Wednesday
15 Thursday Friday Saturday Do not take any capecitabine tablets (unless otherwise instructed) Sunday Do not take any capecitabine tablets
16 Treatment Diary - Week 3 Monday Tuesday Wednesday
17 Thursday Friday Saturday Do not take any capecitabine tablets (unless otherwise instructed) Sunday Do not take any capecitabine tablets
18 Treatment Diary - Week 4 Monday Tuesday Wednesday
19 Thursday Friday Saturday Do not take any capecitabine tablets (unless otherwise instructed) Sunday Do not take any capecitabine tablets
20 Treatment Diary - Week 5 Monday Tuesday Wednesday
21 Thursday Friday Saturday Do not take any capecitabine tablets (unless otherwise instructed) Sunday Do not take any capecitabine tablets
How we produce our information All of our leaflets are produced by staff at The Clatterbridge Cancer Centre and this information is not sponsored or influenced in any way. Every effort is made to ensure that the information included in this leaflet is accurate and complete and we hope that it will add to any professional advice you have had. All our leaflets are evidence based where appropriate and they are regularly reviewed and updated. If you are concerned about your health in any way, you should consult your healthcare team. We rely on a number of sources to gather evidence for our information. All of our information is in line with accepted national or international guidelines where possible. Where no guidelines exist, we rely on other reliable sources such as systematic reviews, published clinical trials data or a consensus review of experts. We also use medical textbooks, journals and government publications. References for this leaflet can be obtained by telephoning 0151 556 5570. If you need this leaflet in large print, Braille, audio or different language, please call 0151 556 5570. If you have a comment, concern, compliment or complaint, please call 0151 556 5203. The Clatterbridge Cancer Centre NHS Foundation Trust Clatterbridge Road, Bebington, Wirral, CH63 4JY. Tel: 0151 556 5000 Web: www.clatterbridgecc.nhs.uk Issue date: 01/02/17 Issue no: 4.0 Reference: LCHPRECT Review date: 01/02/20