Coronavirus and cancer

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CHOP

CHOP is the name of a chemotherapy combination that includes:

  • cyclophosphamide
  • doxorubicin (Adriamycin)
  • vincristine (Oncovin)
  • prednisolone, which is a steroid

It is a treatment for non-Hodgkin lymphoma.

How CHOP works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have CHOP

You have cyclophosphamide, vincristine and doxorubicin as a drip into your bloodstream (intravenously). You have prednisolone (steroid) as tablets that you take with or after food.

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

When you have CHOP

You have CHOP as cycles of treatment. This means that you have the drug and then a rest to allow your body to recover.

Each cycle of treatment usually lasts 21 days (3 weeks). You may have 6 to 8 cycles of treatment in total.

You have each cycle in the following way:

Day 1
  • You have cyclophosphamide as a drip into your bloodstream (intravenously) over about 30 minutes or as a slow injection into your vein.
  • You have doxorubicin as a slow injection into your vein.
  • You have vincristine as a drip into your bloodstream over 5 to 10 mins minutes.
  • You take prednisolone tablets in the morning with or after food.
Day 2 to day 5
  • You take prednisolone tablets in the morning with or after food.
Day 6 to day 21
  • You have no treatment.

You then start the next cycle of treatment. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

You might have other tests such as an electrocardiogram (ECG) to see how well your heart works.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Inflammation of the bladder

Inflammation of the bladder (cystitis) can cause pain and occasionally blood when passing urine. 

Contact your advice line straight away if you see blood in your urine.

Numbness of fingers and toes

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • liver changes that are usually mild – you have regular blood tests to check this
  • lack of energy and strength or feeling unwell
  • changes to how your heart works that may affect your heart rhythm. Other problems include stiffening and inflammation of the heart muscle, heart failure or less blood leaving the heart when it pumps, but this is rare
  • feeling or being sick
  • loss of appetite
  • diarrhoea
  • a sore mouth and throat, you may have ulcers and  pain when swallowing. Other parts of the digestive system can also be affected such as your food pipe that can cause heartburn. Symptoms of the back passage can include diarrhoea, pain, bleeding, discharge and the feeling that you want to pass a bowel movement
  • changes to your face and appearance (Cushing's syndrome) causing a puffy face, stretch marks, acne, increased facial hair or putting on weight around your tummy
  • low levels of potassium in the blood and high levels of sodium – you’ll have regular tests to check this
  • high blood sugar levels  - you’ll have regular blood and urine tests to check this
  • loss of muscle, fat and body mass causing your legs to feel weaker
  • weakening of the bones (osteoporosis) which can cause a break in the bone (fracture)
  • high blood pressure causing swelling in your legs and ankles
  • skin changes such as thinning of the skin and wounds that take longer to heal

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a second cancer that can happen some years later
  • raised levels of potassium, sodium and phosphates caused by the breakdown of cancer cells (tumour lysis syndrome)
  • damage to small blood vessels in the kidneys (haemolytic uremic syndrome)
  • a reaction while you have the drugs – you might get a rash, shortness of breath, redness or swelling of the face and dizziness – tell your team straight away if this happens
  • a stabbing, burning, severe pain anywhere in the body
  • hearing loss which can be partial or total and temporary or permanent
  • flushed skin
  • blood clots that are life threatening; signs are pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung. Contact your advice line or doctor straight away if you have any of these symptoms
  • hardening of veins
  • bleeding in the digestive system
  • tummy pain
  • ulcers or death of tissue in the large bowel
  • areas treated with radiotherapy in the in the past may get sore, have a burning feeling and get dry
  • not enough fluid in your body (dehydration)
  • triggering of previous mental health problems
  • eye problems such as clouding of the lens of the eye (cataracts) or damage to the nerve that connects the eye to the brain (glaucoma)
  • SIADH - increased levels of a hormone causing the body to lose sodium and hold water back

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

  • blocking of the arteries that take blood to the heart and heart attacks after previous radiotherapy to the chest
  • low blood pressure
  • difficulty breathing with wheezing and coughing and pain in the throat. Let your doctor or nurse know immediately if you have this
  • a bowel that stop working (ileus) – symptoms can be a loss of appetite, feeling and being sick, not passing gas or a swollen tummy
  • skin rash
  • pain in the jaw, bones, back, arms, legs or muscles
  • changes to how you wee such as passing large amounts more often than usual, discomfort or pain when going or not being able to empty your bladder
  • headaches
  • redness or irritation around the injection site
  • loss of tendon reflexes and muscle causing problems with walking
  • dizziness or loss of balance (vertigo)
  • loss of sight which can be temporary and rapid eye movements (nystagmus)

What else do I need to know?

Chicken pox and shingles

Keep away from people who have chicken pox or shingles whilst taking steroids if you have never had these illnesses. They could make you very ill.

If you do come into contact with someone who has them, tell your doctor or nurse straight away.

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Grapefruit and grapefruit juice

You should not eat grapefruit or drink grapefruit juice while you are having cyclophosphamide because it may increase the side effects.

Lactose intolerance

Prednisolone contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least a year afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
30 Sep 2020
Next review due: 
29 Sep 2023
  • Electronic Medicines Compendium 

    Accessed June 2020

  • CHOP 21 +/- Rituximab for Non-Hodgkin’s Lymphoma (NHL)
    South East London NHS Cancer Network, 2011

  • Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced Non-Hodgkin's Lymphoma
    R Fisher and others
    The New England Journal of Medicine, 1993. ​Vol 328, issue 14. pages 1002-1006

  • Comparison of a second-generation combination chemotherapeutic regimen (m-BACOD) with a standard regimen (CHOP) for advanced diffuse Non-Hodgkin's Lymphoma
    L Gordon and others
    The New England Journal of Medicine, 1992. Vol. 327, number 19, pages 1342-1349

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

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