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Side effects of doxorubicin and ifosfamide (Doxifos)

Find out about the side effects of the chemotherapy drug combination doxorubicin and ifosfamide (Doxifos).

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection including a temperature above 38C.

The side effects of Doxifos might be different if you have it with other cancer treatments.

Common side effects

Each of these effects happens in more than 10 in every 100 people having this treatment (more than 10%). You might have one or more of these effects.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your advice line or doctor straight away if you have any of these signs, or your temperature goes above 37.5C or below 36C. Severe infections can be life threatening.

Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.

Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently every morning and evening and after each meal.
  • Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

This can affect up to 50 out 100 people (50%).

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

This can happen in about 12 out of 100 people (12%).

You have blood tests before your treatments, to check how well your kidneys are working.

To help prevent damage, it is important to drink plenty of water. You also have fluids into your vein before and after your treatment for several hours.

Your nurse might ask you to keep a record of how much you drink. And you may need to measure the amount of urine that you pass and keep a record of that.

Tell your nurse or doctor if you're not able to drink as much as you should – for example, if you feel sick. And tell them if the amount of urine you pass goes down.

Ifosfamide can cause irritation to your kidneys. You have mesna as either an infusion or tablets to help with this. You might also have some extra fluids through the drip before and after ifosfamide.

Ifosfamide can cause irritation of the bladder. You have another drug called mesna either as a drip or tablets to help with this. You need to take your mesna tablets as your doctor or nurse tells you. 

Tell your doctor or nurse if you notice blood in your urine. 

This won't harm you. It’s due to the colour of the chemotherapy and lasts for one or two days.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

Feeling or being sick can be severe. It can start straight after treatment and last for a few days. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You may need to try different anti sickness medicines to find one that works.

Contact your doctor or nurse straight away if you’ve been sick more than once in a day.

Tips

  • Avoid eating or preparing food when you feel sick.
  • Avoid fried foods, fatty foods or foods with a strong smell.
  • Drink plenty of liquid to stop you from getting dehydrated.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Fizzy drinks help some people when they are feeling sick.

Women might stop having periods (amenorrhoea) but this may be temporary.

Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). Tell your doctor or nurse if this is a problem for you. They can prescribe medicines to help. Try to avoid dust, pollen or animal hairs as they can make the watering worse. 

This happens in more than 20 out of 100 people (20%) and can last for several days after the start of each treatment. 

Your skin is more sensitive to sunlight during your treatment and for several months afterwards. You need to cover up and stay in the shade. Use a high factor sunscreen if you go out in the sun.

When you have this treatment you might:

  • feel confused
  • feel very sleepy
  • have an extreme lack of energy (lethargy)
  • have hallucinations

This can happen in about 12 out of 100 people (12%).

Tell your doctor or nurse straight away if you have any of these effects.

You might have nail changes such as ridges or darkening. Tell your doctor or nurse if you have any nail changes. They can recommend how best to care for them.

Occasional side effects

Each of these effects happens in 1 to 10 out of every 100 people (1 to 10%). You might have one or more of them.

Changes to the heart muscle may happen in some people. This is usually temporary but for a small number of people might be permanent. Your doctor will check your heart before and after your treatment.

The changes are usually very mild and unlikely to cause symptoms. They will almost certainly go back to normal when treatment is finished. 

You have regular blood tests throughout your treatment so your doctor can check this.

Skin changes include darker skin and rashes, which may be itchy.

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, smoothing in unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

You might have soreness, a burning feeling, and dry skin in the areas treated with radiotherapy in the past. Keep affect areas out of the sun. Tell your doctor or nurse if you have a skin reaction. It usually goes away on its own. 

When you're having treatment into your bloodstream tell your nurse straight away if you have any redness, swelling, pain or leaking at your drip site. 

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

There is a small risk that you may get a second cancer some years after this treatment. Your doctor will discuss this with you.

Your eyes might be sore because the drugs cause a reaction on the inside of your eyelids. Or you may not be making enough tears. Your eyes can feel sore and gritty and might be red. Tell your doctor or nurse if you have this. They can prescribe eye drops, ointments or artificial tears for you.

About Doxifos

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help