FOLFOX

Infection

FOLFOX can increase your risk of getting an infection. An infection is an emergency if you are having chemotherapy, and needs treating straight away.

Signs of an infection include:

• a high temperature – your chemotherapy team will tell you what to watch out for
• feeling shivery and cold
• headaches
• sore muscles
• a cough or sore throat
• pain or burning when you pee
• feeling generally unwell or tired.

Call the 24 hour emergency number your chemotherapy team will have given you if you have signs of an infection. You should phone if you have any of these symptoms or feel suddenly unwell, even if your temperature is normal or low.

Read more about infections and how they are treated.

Bruising and bleeding

FOLFOX can lower the number of platelets in your blood. This is called thrombocytopenia . You may bruise more easily than normal, and you may be more likely to have nosebleeds or bleeding gums. If you have a nosebleed that does not stop after five minutes, call the 24 hour emergency number.

Anaemia (low red blood cells)

FOLFOX can lower the number of red blood cells in your blood. This is called anaemia, and can make you feel tired, dizzy or short of breath. If any of these symptoms happen suddenly, call the 24 hour emergency number. If your red blood cell level is very low, you may need to be given blood through a drip. This is called a blood transfusion. Read more about anaemia.

Runny poo (diarrhoea)

If you have diarrhoea, try to drink as much water as you can manage. Call the 24 hour emergency number if you have diarrhoea more than four times a day or are finding it hard to drink enough fluids. You may be given medicines to control the diarrhoea. Your chemotherapy may be delayed until it is better, or the dose of your chemotherapy drugs may be lowered.

Read more about diarrhoea and how it is treated.

Feeling or being sick (nausea or vomiting)

This is a common side effect of FOLFOX but you will be given anti-sickness medicines to stop you feeling or being sick. If these don’t help, call the emergency number. You may be able to change to a different medicine. We have tips for coping with feeling and being sick.

Fatigue (extreme tiredness)

Fatigue is a common side effect of FOLFOX. It is not the same as feeling tired. Fatigue can make you feel weak and have problems concentrating.

Some people find that the fatigue starts a few hours to a few days after having chemotherapy and starts to get better a few days later. There are things that you can do to help with fatigue. Read our tips on coping with it.

Oxaliplatin may also cause dizziness. Feeling tired and dizzy can affect your ability to drive. You might want to get someone else to drive you until you know if you are affected.

Tingling and numbness in your fingertips and toes

FOLFOX can affect the nerves in your hands and feet, which can cause tingling and numbness. This is called peripheral neuropathy. It normally gets better after your treatment finishes. This can be worse in the cold, so wrap up well if you are going outside.

It’s important to tell your chemotherapy team about any tingling or numbness, so it does not become a long term problem. Read more about peripheral neuropathy and how it is managed.

Problems swallowing and breathing (laryngeal spasm)

Oxaliplatin can affect your throat, which can make it hard to swallow or breathe. If this happens when you are being given oxaliplatin, tell your chemotherapy nurse straight away. They may stop the infusion of oxaliplatin while they give you medicine to help with this.

You may also get this side effect in the first few hours after having oxaliplatin. This is normally only if you are out in the cold or have a cold drink. It can be scary but is easily treated by having a warm drink. If you are worried, call the 24 hour number. This side effect should stop a few days after your treatment finishes. Try to avoid cold drinks and wrap up warm if you go out in the cold.

Hair loss

FOLFOX may cause your hair to thin, or you may lose some hair. But it should grow back once your treatment stops. Read more about hair loss and things that can help.

Taste changes

FOLFOX may cause a funny taste in your mouth. Some people say this tastes like metal or cardboard. You may find that food loses its flavour, or you stop enjoying some foods or drinks. This normally gets better once you finish your chemotherapy. You might find our tips for coping with taste changes helpful.

Appetite loss

During your treatment you may not feel like eating, and you may start to lose weight. Try eating small meals often. If your appetite does not get better after a few days, tell your doctor or dietitian. Read our tips for dealing with appetite loss.

Sore mouth and mouth ulcers

FOLFOX can make your mouth sore, or cause mouth ulcers which can be painful. Tell your chemotherapy team about any mouth problems you have. They can make sure you don’t have a mouth infection and give you a mouthwash to help. You should also tell them if you have white spots in your mouth. This is a sign of oral thrush, which is normally easy to treat.

Sore hands and feet

FOLFOX can make the palms of your hands and the soles of your feet red and sore. The skin may also start to peel. Your doctor or nurse may give you creams or painkillers to help with this. If you have badly peeling skin, it is very painful, or you have broken skin that looks infected, call the 24 hour emergency number. The soreness normally gets better when your chemotherapy finishes.

Joint and bone pain

Oxaliplatin can cause problems with your joints, such as swelling or pain. Let your doctor or nurse know if you have this side effect. They can give you painkillers to help. Make sure you check your temperature before taking any paracetamol or ibuprofen. If you have a high temperature, call the 24 hour emergency number straight away.

Skin changes

FOLFOX can make your skin darken or become more sensitive to the sun. Use a high factor sun cream if you are going outside. Tell your chemotherapy team about any skin changes. These changes normally get better when your treatment finishes.

Eye problems

FOLFOX can cause sore, itchy or watery eyes. Tell your doctor or nurse if this happens, as they may need to give you some eye drops. Some people get blurred vision when having FOLFOX, but this is less common.

Heart problems

Fluorouracil (5FU) can cause chest pain. It can also make you feel short of breath, dizzy, or cause an irregular heartbeat. If you have any of these symptoms, call the 24 hour emergency number. If you have chest pain, go straight to A&E and tell them you are having chemotherapy.

Risk of a blood clot in a vein

Chemotherapy can increase the risk of a blood clot in a vein. If you have any pain or swelling in an arm or leg, or you feel short of breath, call the 24 hour emergency number straight away. Or phone an ambulance and tell them you are having chemotherapy. A blood clot is serious if it’s not treated .