1

Dose dense AC-Paclitaxel

chemotherapy guide

For patients with breast cancer

2

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

3

Your health care team

Oncologist:

_______________________________

Pharmacist:

_______________________________

Nurse:

_______________________________

Dietitian:

_______________________________

Social worker:

___________________________________

Medical Day Care: 416-864-5222

2 Donnelly Nursing Unit: 416-864-5099

4

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.

5

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.

6

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.

7

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.

8

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.

9

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).

10

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.

11

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.

12

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.

13

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

14

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

15

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.

16

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.

17

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.

18

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.

19

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.

20

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.

21

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

22

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

23

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.

24

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.

25

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.

26

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.

27

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®

28

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.

29

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.

30

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

31

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.

32

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.

33

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

34

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

36

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

37

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

38

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