CMF chemotherapy Factsheet

CMF chemotherapy
Factsheet
This factsheet is about the
chemotherapy combination CMF. It
explains when it may be used, how it
works and what side effects may
occur during and after having this
treatment.
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02 | Introduction
CMF is a combination of three chemotherapy drugs:
cyclophosphamide, methotrexate and 5 fluorouracil
(also known as 5FU). CMF takes its name from the
initials of these drugs.
There are several combinations of drugs used to treat breast
cancer; CMF is one of them. Your specialist team will discuss
with you which combination is best for your type and stage of
breast cancer.
It is a good idea to read this factsheet with our Chemotherapy
for breast cancer booklet, which describes chemotherapy
treatment in general, explains possible side effects and discusses
some frequently asked questions.
Visit www.breastcancercare.org.uk
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CMF chemotherapy | 03
Who might be offered CMF chemotherapy?
CMF chemotherapy is used to treat people with primary breast
cancer. This is breast cancer that is confined to the breast and/
or in the lymph nodes (glands) under the arm and has not spread
anywhere else in the body. It may be given after surgery, this is
known as adjuvant (additional) treatment.
You will usually be offered chemotherapy if breast cancer cells
have been found in the lymph nodes under the arm. Even if
there are no breast cancer cells found in the lymph nodes,
chemotherapy may be recommended based on other factors
including the size and grade of the breast cancer (how different
the cells are to normal breast cells and how quickly they are
growing). For more information on this, please see our booklet
Understanding your pathology report.
It may also be given to people with secondary breast cancer
(breast cancer that has spread from the breast to another part
of the body). See our Secondary breast cancer booklet for
more information.
Whether you have chemotherapy or not will depend on your
individual circumstances. If you have any concerns regarding
your treatment, it is important to discuss these with your
specialist team.
Call our Helpline on 0808 800 6000
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04 | How does CMF treatment work?
How does CMF treatment work?
All cells divide and grow continually which enables growth and
repair of body tissues, but cancer cells grow by dividing in a
disorderly and uncontrolled way. Chemotherapy destroys cancer
cells by interfering with their ability to divide and grow.
Different chemotherapy drugs work in different ways and attack
the cancer cells at different stages of their growth. This is why a
combination of drugs is often used instead of one single drug.
Visit www.breastcancercare.org.uk
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CMF chemotherapy | 05
How is it given?
Apart from the drug cyclophosphamide, which can also be
given in tablet form, CMF drugs are given directly into a vein
(intravenously). A small plastic tube called a cannula is inserted
into a vein in the back of the hand or lower arm and the diluted
drugs are injected into the tube in turn over a period of several
minutes each.
Sometimes a special intravenous device is used, for example
a skin-tunnelled catheter (a fine tube inserted into a large vein
through a small cut in the chest wall), or alternatively you may
have a PICC (peripherally inserted central catheter) line inserted
into a vein in your arm which extends into the large vein leading
to your heart. Both of these can stay in place until your treatment
is complete.
Your specialist team will be able to explain whether a cannula or
another type of intravenous device is best for you.
Your specialist will explain how your chemotherapy will be given.
There are several different ways of giving CMF and each of these
‘courses’ or ‘cycles’ may be repeated four to six times. The
break between each course of treatment gives your body time
to recover from any short-term side effects that might occur. The
intervals between the treatments may vary depending on how
well your cells recover between cycles. See the ‘Common side
effects’ section of this factsheet for more information.
The dose of chemotherapy is calculated for each individual,
based on their weight and height. The total length of treatment is
usually four to six months.
You will normally be given your treatment as an outpatient so
you will be able to go home the same day. Each time you have
chemotherapy you should expect to be at the hospital for most
of the day to allow for waiting time, blood tests, the drugs to be
prepared and treatment to be given.
Call our Helpline on 0808 800 6000
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06 | What are the possible side effects of CMF?
What are the possible side effects of CMF?
Like any treatment, CMF chemotherapy can cause side effects.
Everyone reacts differently to drugs and some people have more
side effects than others. These can usually be controlled. Some
people find it helpful to keep a diary of how they are feeling during
their chemotherapy so they can discuss this with their nurse or
specialist team.
If you are concerned about side effects, it is a good idea to talk
to your chemotherapy nurse or someone in your specialist team.
Also, if you notice any side effects not listed here that concern
you, we recommend you talk to your specialist team.
Some people find complementary therapies helpful in managing
some of the side effects. It is important to discuss with your
specialist team any complementary therapies, supplements
or herbal remedies before you start them, as some may react
with the cancer treatment. For more information, see our
Complementary therapies booklet.
Visit www.breastcancercare.org.uk
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CMF chemotherapy | 07
Common side effects
Effects of administering CMF
While the drug cyclophosphamide is being injected you may
feel hot or flushed and slightly dizzy, and have an itchy nose or
a metallic taste in your mouth. These feelings usually go away
when the injection is finished, but tell your nurse if you experience
any of them. Asking to have the drug given more slowly can
sometimes help.
Bone marrow suppression
Chemotherapy drugs can affect blood cells within the body and
in bone marrow (the spongy material found in the hollow part of
bones) where blood cells are made. Blood cells (white blood cells,
red blood cells and platelets) are released by the bone marrow
to replace those which are naturally used up within the body.
Chemotherapy reduces the ability of the bone marrow to make
these cells.
A low white cell count can increase the risk of getting an infection.
If you feel unwell, develop a sore throat, cough, shivering or a
temperature above 38 degrees centigrade during your treatment,
you should contact the hospital immediately, even if this happens
at the weekend or during the night. You may need to be treated
with antibiotics. Your specialist team will give you details of who to
contact at any time during your treatment.
Before each cycle of chemotherapy begins (and sometimes during
a cycle) you will have a blood test to ensure that your blood cell
count is within safe limits to have the treatment, and that the cells
have recovered from the previous cycle. If the number of blood
cells is too low, it may be necessary to delay the next course of
treatment or to reduce the dose of chemotherapy you are given.
Sometimes people having chemotherapy develop anaemia
because of a low red cell count. If you feel particularly tired,
breathless or dizzy you should let your specialist team know.
Although these symptoms can also be due to other causes, it is
Call our Helpline on 0808 800 6000
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08 | Common side effects
important to report them. Occasionally a blood transfusion may
be necessary at some point during your treatment.
Because CMF can reduce the number of platelets (which help
the blood to clot), you may find during your treatment you bruise
more easily, have nosebleeds or notice that your gums bleed
when you brush your teeth. You should tell your specialist team if
you experience any of these symptoms. A platelet transfusion can
be given, although this is rarely needed, as platelet levels usually
correct themselves over time.
Nausea and vomiting
You may experience nausea and vomiting, which can start
immediately after chemotherapy or several hours later. It may last
for several hours or may even continue for several days. However,
it can usually be controlled or lessened with anti-sickness drugs.
You should contact your hospital if your symptoms don’t improve.
Anti-sickness drugs are routinely prescribed with chemotherapy
to help prevent nausea. If these don’t work, other anti-sickness
drugs may be prescribed.
Diarrhoea
You may experience diarrhoea during your chemotherapy
treatment. If this happens, let your specialist team know, as
medication can be prescribed to help control it. It is
important to drink plenty of water to prevent yourself from
becoming dehydrated.
Sore mouth
You may develop a sore mouth or gums, or mouth ulcers. Tell
your specialist team if any of these occur as they can prescribe
special mouthwashes and medicines to help. Good mouth
hygiene is very important during treatment. If you already have a
dental problem such as cavities or gum disease, see your dentist
so that it can be sorted out before treatment starts.
Visit www.breastcancercare.org.uk
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CMF chemotherapy | 09
Fatigue (extreme tiredness)
You may feel extremely tired during your treatment and some
people find this fatigue lasts for several months after their
treatment has finished. If you become anaemic (have a low
amount of red blood cells), you may be more prone to fatigue, but
it can still occur even if your blood levels are normal. Research
has shown regular exercise such as walking can really help
improve your feelings of fatigue. Walking 20 minutes each day
may improve your feelings of fatigue and your fitness levels.
Although this may be difficult at first, if built up gradually, it usually
becomes easier with time.
Your energy levels can be improved by drinking plenty of fluids
and eating small amounts regularly, particularly when your
appetite is good. Foods which boost energy, such as nuts and
bananas, may also help with fatigue.
You may find that your concentration is affected by treatment.
Although this can be frustrating, most people find it generally
improves following treatment. This is sometimes called
‘chemo-brain’ or ‘chemo-fog’ and usually improves over time after
treatment has finished.
It’s worth telling your doctor or nurse how you feel as there are
ways in which the fatigue may be treated.
Sore eyes and runny nose
CMF can cause dry, sore, gritty feeling eyes and a runny nose. Or
you may notice that your eyes water. Sometimes eye drops can
be prescribed to relieve the soreness.
Bladder irritation
It is important to drink plenty of fluids when you have your
treatment as chemotherapy drugs (particularly cyclophosphamide)
can irritate the lining of the bladder. Tell your specialist if you notice
any irritation or a burning/stinging sensation when passing urine.
Call our Helpline on 0808 800 6000
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10 | Common side effects
Hair thinning
You may notice that your hair thins during your treatment. On
very rare occasions you may lose all of your hair. This will grow
back once treatment is finished. Your hair is likely to thin more if
you are having cyclophosphamide injections rather than tablets.
For further information see our booklet Breast cancer and
hair loss.
Infertility (temporary or permanent)
Chemotherapy can affect the function of the ovaries resulting in
less or no eggs being produced, which can affect fertility. While
some women are unaffected, others may find that their periods
become irregular or stop temporarily or completely, which may
mean permanent infertility. Although they may return, women
aged around 40 and above are less likely to get their periods
back after completing chemotherapy than younger women. If
your periods stop this may result in menopausal symptoms such
as hot flushes and vaginal dryness. You may find our factsheet
Menopausal symptoms and breast cancer helpful if you are
experiencing symptoms.
Studies show that CMF is more harmful to the ovaries than
some other types of chemotherapy. If you are concerned about
your fertility, it is important to talk to your specialist team before
treatment begins. If you want to know more about preserving your
fertility or pregnancy after treatment, see our Fertility issues
and breast cancer treatment factsheet.
Some women can still become pregnant when receiving
chemotherapy, even if their periods are affected. This may have
a harmful effect on the developing baby, so effective barrier
contraception such as a condom must be used.
Visit www.breastcancercare.org.uk
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CMF chemotherapy | 11
For more information see our publications:
Chemotherapy for breast cancer BCC16
Understanding your pathology report BCC161
Secondary breast cancer BCC58
Complementary therapies BCC55
Breast cancer and hair loss BCC54
Menopausal symptoms and breast cancer BCC18
Fertility issues and breast cancer treatment BCC28
To order, or download a copy, please visit
www.breastcancercare.org.uk/publications
Call our Helpline on 0808 800 6000
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12 | Further support
Further support
If you have any questions or concerns about CMF chemotherapy
you can talk to your specialist or breast care nurse. You may
also find it helpful to talk with someone who has had a similar
experience to you. You can do this one-to-one or in a support
group. For more information on individual support or support
groups in your area, call our Helpline or see the map of services
on our website www.breastcancercare.org.uk
Breast Cancer Care
From diagnosis, throughout treatment and beyond, our
services are here every step of the way. Here is an overview of
all the services we offer to people living with and beyond
breast cancer.
Our free, confidential Helpline is here for anyone who has
questions about breast cancer or breast health. Your call will be
answered by one of our nurses or trained staff members with
experience of breast cancer.
Our website gives instant access to information when you need
it. It’s also home to the largest online breast cancer community
in the UK, so you can share your questions or concerns with
other people in a similar situation.
Our One-to-One support service can put you in touch with
someone who knows what you’re going through. Just tell us
what you’d like to talk about and we can find someone who’s
right for you.
Through our professionally-hosted Discussion Forums you can
exchange tips on coping with the side effects of treatment, ask
questions, share experiences and talk through concerns online.
If you’re feeling anxious or just need to hear from someone
else who’s been there, they offer a way to gain support and
reassurance from others in a similar situation to you.
Visit www.breastcancercare.org.uk
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CMF chemotherapy | 13
We host weekly Live Chat sessions on our website offering you
a private space to discuss your concerns with others – getting
instant responses to messages and talking about issues that are
important to you.
If you find it difficult to talk about breast cancer, we can answer
your questions by email instead – our Ask the Nurse service is
available on the website.
We run Moving Forward Information and Support
Sessions for people living with and beyond breast cancer.
These sessions cover a range of topics including adjusting and
adapting after a breast cancer diagnosis, exercise and keeping
well, and menopause. In addition, we offer Lingerie Evenings
where you can learn more about choosing a bra after surgery.
We also offer a HeadStrong service where you can find
alternatives to a wig and meet other people who understand
the distress of losing your hair. Our Younger Women’s Forums,
Living with Secondary Breast Cancer courses and SECA
Support Groups for people with secondary breast cancer are
also here to offer specific, tailored support.
Our free Information Resources for anyone affected by
breast cancer include factsheets, booklets and DVDs. You can
order our publications by using our order form, which can be
requested from the helpline. All our publications can also be
downloaded from our website.
To request a free leaflet containing further information about our
services for people having treatment for breast cancer please
contact your nearest centre (contact details at the back).
Call our Helpline on 0808 800 6000
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14 | Further support
Other organisations
Macmillan Cancer Support
89 Albert Embankment
London SE1 7UQ
General enquiries: 020 7840 7840
Helpline: 0808 808 0000
Website: www.macmillan.org.uk
Textphone: 0808 808 0121 or Text Relay
Macmillan Cancer Support provides practical, medical, emotional
and financial support to people living with cancer and their carers
and families. Over the phone, its cancer support specialists can
answer questions about cancer types and treatments, provide
practical and financial support to help people live with cancer,
and are there if someone just wants to talk. Its website features
expert, high-quality information on cancer types and treatments,
emotional, financial and practical help, and an online community
where people can share information and support. Macmillan also
funds expert health and social care professionals such as nurses,
doctors and benefits advisers.
Visit www.breastcancercare.org.uk
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This factsheet can be downloaded from our website,
www.breastcancercare.org.uk It is also available in
large print, Braille or on audio CD on request by
phoning 0845 092 0808.
This factsheet has been produced by Breast Cancer
Care’s clinical specialists and reviewed by healthcare
professionals and people affected by breast cancer.
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Breast Cancer Care is here for anyone affected
by breast cancer. We bring people together,
provide information and support, and campaign
for improved standards of care. We use our
understanding of people’s experience of breast
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Visit www.breastcancercare.org.uk or call our
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