CAPOX Side Effects

CAPOX side effects can be difficult. As a long-term cancer survivor, I, unfortunately, have a lot of experience with the downside of cancer treatments. The list of common CAPOX side effects is linked below.

While CAPOX side effects can be difficult, they can be managed. Prehabilitation, diet, supplementation, and lifestyle therapies have been cited to reduce the severity of side effects at the very least, and possibly eliminate some.

Reducing the neurotoxic side effects of adjuvant chemotherapy for colon cancer

Of the many side effects mentioned below, peripheral neuropathy seems to be the side effect that is the most common and the most difficult. An evidence-based, non-conventional therapy shown to reduce CIPN is acupuncture.

Have you had CAPOX chemotherapy? Did you experience side effects? Which ones? Short-term? Long-term? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thanks,

David Emerson

Cancer Survivor
Cancer Coach
Director PeopleBeatingCancer

Oxaliplatin and capecitabine (CAPOX, XELOX)

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Numbness and tingling in the hands and feet

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment. Tell your healthcare team if you’re finding it difficult to walk or complete fiddly tasks such as doing up buttons.

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling 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.

Breathlessness and looking pale

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

Bruising, bleeding gums, nosebleeds, or bleeding from other areas of the body

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. This is known as petechiae.

Less commonly you might also bleed from other areas of the body for other reasons. For instance, some people might notice their poo is quite dark or they might pass fresh blood. Rarely some people might cough up blood or have unusual bleeding from the vagina.

Let your healthcare team know straight away if you have any bleeding.

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.

Allergic reaction

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 and give you medicine to help relieve your symptoms.

Increased sensitivity to 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 a few 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 before and after oxaliplatin.

Let your nurse know straight away if it’s affecting your breathing and swallowing. They can slow down your drip if this happens.

Changes to levels of substances in the blood

This treatment can cause your blood sugar and sodium levels to go up. Or your level of potassium might go down. Less commonly your calcium levels might drop.

You will have regular blood tests to check on these.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma Open a glossary item , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables.

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Sore mouth

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Less commonly you might have a dry mouth.

Loss of appetite

You might lose your appetite for various reasons while 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.

Tummy (abdominal) pain

Tell your treatment team if you have this. They can check the cause and give you medicine to help.

Headaches

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

Soreness, redness and peeling on hands and soles of the 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 healthcare team will tell you what moisturiser to use.

It is important to keep hands and feet well moisturised.

Skin problems

Skin problems include a skin rash which might be red and itchy. Less common skin problems might include your skin getting dry, peeling, blistering, cracked, and changes in skin colour. Other rare skin changes include ulcers, raised areas of skin that may be itchy, being sensitive to sunlight and previously treated areas of skin with radiation can become irritated and inflamed

This usually goes back to normal when your treatment finishes. Your nurse will tell you what products you can use on your skin to help.

Hair loss

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

Pain in different parts of your body

This treatment can cause back pain. Or you might get pain from other areas of the body such as in your muscles and joints.

Inflammation and pain at your drip site

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

High temperature (fever)

If you get a high temperature, let your health care team know straight away. Ask them if you can take paracetamol to help lower your temperature.

Weight changes

You may gain weight while having this treatment. Or less commonly you may lose weight.

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.

Difficulty breathing or a cough

It is important to tell your doctor or nurse if you have a cough or are breathless. This could be a sign of infection or more rarely lung problems such as asthma, a blood clot in the lung, a collapsed lung (pneumothorax), or changes to the lung tissue, making it less flexible.

Constipation

Constipation Open a glossary item is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Liver problems

This includes inflammation of the liver and changes to the levels of liver enzymes. You have regular blood tests to check for this.

Rarely you might have yellowing of the skin and whites of the eyes.

High blood pressure

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. You have your blood pressure checked regularly.

Fluid build up in your legs, ankles and feet

You may have swelling of your hands and legs due to a build up of fluid (oedema).

Eye problems

You may have watery eyes due to an increase in the production of tears.

Swallowing problems or indigestion

You might have a sore throat, difficulty swallowing or indigestion. Speak to your healthcare team if this is a problem for you.

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

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