PACL

Hair thinning or loss 

• Generally starts 2 to 3 weeks after the first injection.
• Use a gentle shampoo and a soft hairbrush. Avoid dyes, perms, bleaches and hair sprays.
• Protect your scalp from sun exposure and cold weather.
• This is expected. Your hair usually grows back after your chemotherapy is finished, but hair loss may be permanent in some cases.

Muscle or joint pain

• May happen 2-8 days after each Paclitaxel infusion and may resolve within 4 to 7 days.
• Take 1-2 Acetaminophen tablets every 4 hours if needed for pain.
• Contact your oncologist if this becomes bothersome.

Diarrhea

• May happen a few days after your treatment
• Limit hot, spicy, and fried foods; limit foods and drinks with caffeine.
• Drink plenty of fluids. Phone your doctor if diarrhea lasts longer than 24 hours.
• See Diarrhea pamphlet.*

Tiredness or weakness; Lack of energy

• May increase with the number of cycles given.
• Eat well-balanced meals. Some mild exercise, such as walking, may help.
• Rest when feeling tired or weak. Don't drive a motor vehicle or operate machinery.
• Your energy level will improve over time. However, it may take a few months for the tiredness to go away even after your chemotherapy is finished.

Flu-like symptoms (usually mild) - fever, chills, headache, muscle & bony aches, cough, and stuffy nose

• This may happen shortly after your Trastuzumab treatment.
• These symptoms usually disappear on their own.
• Take Acetaminophen (e.g. Tylenol®) 1 or 2 tablets every 4 hours, as needed for aches and pains.
• If the pain or coughing continues and is bothersome after 2 to 4 days, call your oncologist or nurse.

Sores in the mouth or the lips

• May start a few days after treatment begins.
• Maintain good mouth hygiene. Brush teeth often with a soft toothbrush.
• Avoid hot, spicy and acidic foods.
• Avoid commercial mouthwashes. See Mouth Care pamphlet.*
• Check with your oncologist or nurse as soon as you notice sores on lips or tongue and in the mouth.

Signs of infection, for example, fever, chills, cough, sore throat

• The risk of infection is greatest between days 8 to 21.
• Limit contact with people who are sick or have colds. Wash your hands often.
• Phone your oncologist or go to the closest emergency room right away if you have a fever*
• *You have a fever if your temperature taken in your mouth (oral temperature) is:
• 38.3°C (100.9°F) or higher at any time OR
• 38.0°C (or 100.4°F) or higher for at least one hour.
• While you are getting chemotherapy treatments:
• Keep a digital thermometer at home and take your temperature if you feel hot or unwell (for example, chills).
• Avoid taking medications that treat a fever before you take your temperature (for example, Tylenol®, acetaminophen, Advil® or ibuprofen) as they may hide a fever.
• Do not eat or drink anything hot or cold right before taking your temperature.
• Check with your doctor before getting any vaccines, surgeries, medical procedures or visiting your dentist.

Chills or fever during infusion

• More common during the first trastuzumab infusion.
• Your treatment may be given more slowly and drugs may be given to you to treat the reaction.
• If you develop this reaction, you may also receive drugs before your next cycle of trastuzumab to prevent this.
• Tell your nurse or oncologist immediately if you have a reaction during the treatment.

Numbness, tingling and burning sensation in hands and feet

• This sometimes starts after a few treatments
• Usually mild and temporary, gradually goes away.
• Be careful when handling items that are sharp, hot or cold.
• Check with your oncologist or nurse if this is bothersome and affecting your daily living.