Active symptom control and vinorelbine (N) chemotherapy

Active symptom control is given as described previously. You will also have a chemotherapy drug called vinorelbine. The vinorelbine is given by injection through a small tube (cannula) into a vein in the back of your hand, and is followed by a drip to flush the drug through.

This whole process takes about 30 minutes and is repeated every week for six weeks. Then, after a two-week rest, the vinorelbine is again given every week for six weeks.

The vinorelbine treatment usually takes place in the outpatients clinic and the whole course of treatment takes just over three months. A blood test is taken before each chemotherapy session.

Vinorelbine does not normally cause much nausea or sickness, but you will be given anti-sickness medicines as tablets or through a drip before the treatment. You will be given tablets to take for up to a few days afterwards to help deal with any sickness (nausea).

Possible side effects

Temporary reduction in bone marrow function This treatment can result in a reduction of the number of white cells (which fight infection) in your blood, making you more prone to infection. It can also result in bruising or bleeding if your platelets (cells which clot the blood) are reduced, or anaemia if the number of your red blood cells is low.

This effect can begin about seven days after the treatment has been given and may continue for a few weeks after the chemotherapy has ended. You will have a blood test before each chemotherapy session to check the levels of your various blood cells.

Contact your doctor or the hospital straight away if:

• your temperature goes above 38ºC (100.5ºF)
• you start shivering
• you have any unexplained bruising or bleeding or you suddenly feel unwell (even with a normal temperature)

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a common side effect and it is important to try and get as much rest as you need.

CancerBACUP’s section on coping with fatigue has helpful advice on this.

Hair loss This is uncommon; hair usually thins rather than being lost completely.

Hair loss tends to start 2-3 weeks after the first cycle of treatment but is temporary: your hair will start to grow again when the treatment ends.

CancerBACUP has a section with more information on coping with hair loss.

Taste change You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Numbness or tingling in hands or feet or jaw pain This is due to the effect of vinorelbine on nerves. Tell your doctor if you notice these symptoms. The problem usually improves slowly a few months after treatment is over.

Aching joints and muscles You may have these symptoms a few days after treatment. This does not usually last long and your doctor can prescribe painkillers to help.

Skin rashes Vinorelbine may cause skin rashes. Your doctor can prescribe medicines to reduce this problem.

Blood clots Vinorelbine can make some people more likely to get blood clots. The risk of blood clots is still usually low, but it is very important to let your doctor know if you have any redness or swelling of a limb, as this could be a sign of a blood clot. Once the treatment is ended the risk goes back down to normal.

Constipation This can usually be relieved by drinking plenty of fluids, eating a high-fibre diet and taking gentle exercise. Your doctor can prescribe laxatives to help to reduce constipation.

CancerBACUP’s section on diet and the cancer patient has helpful tips on dealing with constipation.

Pain at the injection site When the vinorelbine is given it may cause an uncomfortable sensation, and sometimes pain, at the injection site. If this happens, let your doctor or nurse know as they can change the way that they give the drug, and can give painkillers to reduce the sensation.

The area around the injection site may become slightly red after the injection. Let your doctor know if the redness continues or gets very sore.