Coronavirus and cancer

We know it’s a worrying time for people with cancer, we have information to help. If you have symptoms of cancer contact your doctor.

Read our information about coronavirus and cancer

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EOX

EOX is the name of a chemotherapy combination that includes:

  • E – epirubicin
  • O – oxaliplatin
  • X – capecitabine (Xeloda)

You might have it as a treatment for oesophageal or stomach cancer. 

How EOX works

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

How you have EOX

You have epirubicin and oxaliplatin in a drip into your bloodstream (intravenously). And you take capecitabine as tablets.

Into your bloodstream

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.

You take capecitabine twice a day. You should take them within 30 minutes after eating a meal (breakfast and dinner). You swallow them whole with water. 

Taking your tablets

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

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

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

When you have EOX

You have EOX chemotherapy as cycles of treatment. A cycle of treatment means that you have a combination of drugs, and then have a rest to allow your body to recover. Each cycle lasts 3 weeks (21 days). Depending on your cancer type you have between 6 and 8 cycles.

You have each cycle of treatment in the following way:

Day 1
  • you have epirubicin as an injection into your vein
  • you have oxaliplatin as a drip over 2 hours
  • you take capecitabine as tablets in the morning and evening about 12 hours apart
Day 2 to Day 21
  • you take capecitabine as tablets in the morning and evening about 12 hours apart

You then start a new treatment cycle.

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.

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 or radiotherapy.

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 advice line or your doctor or nurse immediately if you have signs of infection, such as a temperature above 37.5C or below 36C, or if you develop a severe skin reaction. Signs of a severe skin reaction include peeling or blistering of the skin.

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 and 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).

Less often bleeding can happen from other areas of the body such as your gut and back passage (rectum). Let your medical team know if you notice any blood from your rectum or in your poo.

Feeling or being sick 

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Breathlessness and looking pale

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

Blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

High temperature (fever) and rigors

You might get a high temperature (fever) with a sudden feeling of being cold, shivering and sweating (rigor). Contact your health advice line, doctor or nurse know straight away. Ask them if you can take paracetamol to help lower your temperature.

Tummy (abdominal) and back pain

Tell your treatment team if you have this. They can work out the cause and give you medicine to help relieve the pain.

Sore mouth and ulcers

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Numbness and tingling in fingers and toes

Numbness or tingling in fingers or toes is often temporary and can usually improve slowly after you finish treatment. Talk to the team looking after you when you first notice this, especially if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons. 

Increased sensitivity to the cold

Oxaliplatin can make you more sensitive to the cold. It can affect your throat causing it to feel as though it is difficult to breathe and swallow. This can happen whilst you have oxaliplatin or within 2 hours of it finishing. It’s only temporary but can feel quite frightening.

Opening and closing the fridge or freezer, touching metal, eating or drinking cold foods and changes in temperature from the weather can trigger this. 

It can help wearing gloves and avoid very cold food and drink for 24 hours before and after oxaliplatin.

Let your nurse know straight away if it's affecting your breathing and swallowing.

Hair thinning and loss

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

Loss of appetite

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

Taste changes

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Red or pink urine 

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

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.

Let your doctor or nurse know as you may be able to have creams to help manage this.

Skin and nail problems

Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.

Skin flushing

Your skin may redden and appear flushed.

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Inflammation around the drip or injection site

Tell your nurse straight away if you have any pain, redness, swelling or leaking around your drip site.

Also let them know if it causes pain along the vein when you have the injection. 

Allergic reactions

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after treatment.

Changes to your periods

Women might stop having periods (amenorrhoea) but this may be temporary. This is a side effect from the chemotherapy only. 

Eye problems

You might have eye problems, including watery eyes, irritation and redness (conjunctivitis).  Other less common symptoms include blurred or double vision and eye pain.

Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.

Indigestion or heartburn

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Cough or breathing problems

You might develop a cough or difficulty breathing due to an infection such as pneumonia. Or it can just be due to the drugs. Let your team know immediately if this happens.

Weight gain

You may gain weight while having this treatment. You may be able to control it with diet and exercise. Tell your doctor or nurse if you are finding it difficult to control your weight. 

Changes to the way your liver works

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

High blood pressure 

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

High blood sugar levels

High blood sugar levels can cause headaches, feeling thirsty and blurred vision. You have regular tests to check your blood sugar levels. You may need to check your levels more often if you are diabetic.

Changes in levels of salts or minerals in your blood

You may have changes in levels of minerals and salts in your blood, such as low potassium and high or low sodium. Less often these drugs can make your bloods show low levels of calcium and magnesium.

You have regular blood tests during treatment to check this.

Fluid build up in your legs, feet and hands

You may have swelling of your legs and feet due to a build up of fluid (oedema). Less commonly you might get swelling of the hands.

Kidney changes

You might have some changes in the way your kidneys work. You'll have regular blood tests to check how well they are working.

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: 

  • constipation
  • heart problems such as slow, fast or irregular heartbeat. You may have tests to check how well your heart is working before starting chemotherapy
  • a dry mouth
  • lack of fluid in the body (dehydration)
  • passing wind (flatulence)
  • chills
  • depression
  • difficulty sleeping (insomnia)
  • dizziness
  • infections affecting the sinuses, throat, breathing tubes or lungs – some other infections include shingles and oral thrush
  • hiccups
  • pain in your gut, joints, bones, jaw, and chest
  • damage to the muscles and nerves causing locked jaw (trismus) – you’re unable to open your mouth completely
  • problems with moving your body causing weakness, clumsiness, loss of balance and falls
  • an increase in sweating
  • blood in your urine
  • problems passing urine
  • inflammation of the membranes covering the brain and spinal cord (meninges) causing symptoms similar to meningitis such as stiff neck, headaches and unable to look at bright light
  • low blood pressure
  • hearing changes – ringing or buzzing in the ears (tinnitus) or loss of hearing
  • difficulty speaking (dysphonia)
  • a sore throat

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 severe whole body infection that can be life threatening (sepsis)
  • a second cancer such as acute lymphoblastic leukaemia (ALL) or acute myeloid leukaemia (AML)
  • the abnormal breakdown of red blood cells
  • nervousness
  • the imbalance of chemicals in your blood making it too acidic this can cause fast breathing, confusion, sleepiness, fatigue, or fast heart rate
  • blockage or slow movement of the gut
  • blood clotting problem causing bruising and severe bleeding
  • scarring and thickening of the lung tissue causing difficulty breathing
  • an increase in uric acid in the blood that can cause inflamed joints - you have regular blood tests to check this

Other side effects

For more information about the side effects of individual drugs:

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. Talk to your doctor if you are worried and about whether you need to have a test to check for it. 

Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.

Other medicines, foods 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.

Lactose intolerance

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

Pregnancy and contraception

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 and for at least 6 months 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.

Information and help