A combination of chemotherapy drugs is often used when treating colorectal cancer. FOLFOX is one of the most used chemo regimens used. It's a combination of leucovorin calcium (folinic acid), fluorouracil (5-FU), and oxaliplatin. While it's effective, there are side effects that patients can expect. The severity of the side effects varies from person to person and is impacted by the dose and how often the treatment is given.
To help prepare for this life-saving colorectal cancer treatment, it's a good idea to review the most common side effects and what you can do to manage and minimize their effects.
FOLFOX is typically given in an outpatient setting over the course of two days. On the second day, most patients go home with a mobile IV system. Because of the long infusion time and the combination of drugs, FOLFOX side effects tend to be more intense than other chemotherapy treatments. While most side effects get better after treatments are complete, some may last longer or become permanent.
Fatigue is one of the most common side effects of FOLFOX — and most cancer treatments. Even if you're normally full of energy, you're going to feel tired. Some describe it as exhaustion, even if they had a good night's rest. It’s important to have someone with you to assist with daily tasks so you can rest as much as possible. When you feel up to it, try to participate in some physical activity. It seems the opposite of resting, but taking a short walk or going through a few yoga poses can help boost energy for the rest of the day. Just don't overdo it, and try to eat a balanced diet without added sugar to help keep your energy level up.
Chemotherapy can cause a loss of appetite. It may also influence how food smells or tastes, and you may not feel like eating due to nausea. On days when you don't feel hungry, try to eat small amounts of bland food (especially if you're nauseous) until you are ready to graduate to other types of food. If you’re unable to hold down foods or liquids, your doctor may require that you be put on an IV so that your body gets hydration and nutrition. When you can eat, try to avoid sugars and foods that are hard to digest — especially if you're recovering from colon surgery.
Instead of eating three meals per day, try to snack every few hours. Foods high in protein are a good idea because they help your body's cells repair. Eating small, frequent meals can also help manage nausea.
Related reading: What to Expect If Surgery Is Part of Your Colorectal Cancer Treatment Plan
Sensitivity to Cold and Hot Temperatures
The FOLFOX chemotherapy drugs can cause nerve damage, especially in your hands and feet. This condition is called peripheral neuropathy. The nerves may cause tingling, burning, or numbness. It also increases sensitivity to both hot and cold items, especially when reaching into the refrigerator or picking up a hot cup. Compression socks may help improve circulation in your feet if they feel tingly. You may also want to have a pair of gloves in the kitchen so you can wear them when touching anything hot or cold.
Chemotherapy weakens the immune system by damaging both cancerous and healthy cells, including the white blood cells your immune system uses to fight off viruses and bacterial infections. Patients with colorectal cancer are especially vulnerable to mucositis, a painful inflammation of the digestive tract.
Before starting treatment, talk to your colorectal cancer doctor about the risk of developing mucositis. You may be prescribed filgrastim injections to boost the development of white blood cells. To help protect your immune system, try to wash your hands frequently with plenty of soap and lukewarm water, avoid close contact with sick people, and avoid crowded places.
Thinning hair is a common side effect of FOLFOX treatment; however, it is usually temporary. Most people will regrow their hair following treatment and many don't lose all of their hair during treatment. To help with this, try washing your hair less frequently. Use higher-quality products including a mild shampoo and conditioner. Avoid excessive heat on your head including styling tools. Consider sleeping on a silk pillowcase because there is less friction with hair follicles.
Chemotherapy treatment may lead to dryness or rashes and increased sensitivity to the sun, which can lead to easier sunburns. Be mindful to wear sunscreen and apply moisturizer as needed.
FOLFOX chemotherapy sometimes causes anemia. This means your body produces fewer red blood cells to carry oxygen throughout your body. Anemia can appear in different ways. Symptoms include weakness and dizziness, looking pale or grey, headaches and shortness of breath. Your oncologist will monitor your red and white blood cell count throughout treatment. If your red blood cell count gets too low, you may need a transfusion. There are also some drugs to help stimulate red blood cell production. Be gentle with yourself, allow plenty of time to rest, and move a little slower. Ask for assistance to help with movement, and try to eat iron-rich foods such as spinach, almonds, eggs, chickpeas, kidney beans, and edamame (soy).
Many patients recently had colon surgery prior to receiving FOLFOX. This can make it harder to digest food. However, even if chemotherapy is your first line of treatment, you might experience nausea, constipation, diarrhea, gas, bloating, or cramping. It’s important to follow your oncologist’s advice about proper diet and foods to avoid. Try your best to eat intentionally during this time so that your body still gets the proper nutrition.
Stock up on the foods that you will need after a treatment session. Consult your doctor about prescription and over-the-counter medications that may help with diarrhea, constipation, gas, and bloating.
Chemotherapy can sometimes cause sores to form on the soft tissue of the inside of your mouth. The most commonly impacted areas are the tongue, cheeks, lips, and gums. Sores in the mouth may make it difficult to speak or eat properly and cause significant discomfort, which could increase irritability. Try to keep your mouth moistened. If you feel like you have dry-mouth from the chemotherapy, there is an oral rinse you can try. You should also try to during plenty of water and avoid dehydrating beverages like alcohol or caffeinated drinks.
Please note that most side effects typically improve after treatment. However, some side effects, such as neuropathy, may be long-lasting. Other side effects, like fatigue or bowel issues, could last up to one year following treatment. It may be necessary to have physical therapy to help with some of the other side effects.
At Compass Oncology, we believe educating our patients is a proactive approach so that you are as prepared as possible for your treatment.
If you or someone you know was diagnosed with colorectal cancer or any other GI cancer, it's important to have a customized treatment plan.
FOLFOX may not be a part of your particular plan for colorectal cancer. However, no matter which treatments you receive, be sure to discuss how you're feeling at your appointments and reach out to your cancer care team between appointments if you're experiencing something new.
We care for patients with GI cancers in the Portland, OR, and Vancouver, WA areas. Find a cancer center near you to schedule a consultation with a colon cancer doctor.