Chemotherapy ACT Treatment for Breast Cancer

ACT chemotherapy is an anagram for the three different drugs that are used in the treatment for breast cancer: Adriamycin (Doxorubicin), Cyclophosphamide (Cytoxan), and Taxol (Paclitaxel). It is often listed as AC + T as the first two drugs are given first at the same time followed by the third. Here is what you need to know if this is what you are prescribed.

What Is ACT Chemotherapy Treatment

ACT treatment for breast cancer is a combination of drugs that when used together can work effectively in the fight with the beast that is cancer. This chemo cocktail lowers your bone marrow’s ability to make blood cells, so your oncologist may prescribe an injectable medication to increase your white blood cell count.

The Doxorubicin part is a vein vesicant and will cause tissue damage if it somehow leaks from the vein. Your oncologist may order you a PICC line to be installed – this is to protect the veins and tissue from damage. While uncomfortable when first installed, a PICC line makes the rest of your chemo treatments a breeze. Doxorubicin is red, and is often referred to as the ‘red devil’. It’s very strong and will turn your urine a reddish color after chemo (doesn’t last long and is gone a few hours later).

You will need to go in for labs to check your blood work to make sure you are healthy enough to handle another round of chemo. This will be done the day before chemo or right before chemo, and if something doesn’t look stellar, then your chemo may be rearranged to make sure you are well enough. This is done with each round.

Chemo brain. Yes, there is such a thing, and yes, you will suffer from it. Your short term memory will be gone and little things like creating shopping lists will become the bane of your existence. For me, this was a profound effect. Three times I literally lost my car in the parking lot of the local grocery store. And I always tried to park in the same area. But when you exit the building and completely are in a fog, then you are pretty much done for. Write things down because you will forget them, things like dates, times, places, etc.

Side Effects of AC Chemo Treatment (Adriamycin/Doxorubicin and Cyclophosphamide)

Immediate side effects are nausea, nausea, and more nausea. The day of chemo, the chemo nurses gave me a mild sedative (I always fell asleep during this treatment for about an hour) as well as antinausea meds. I was given three different prescription medications to counteract this side effect at home so that this side effect was kept at bay for the most part. I was prescribed Olanzapine, Zofran, and Compazine. I took these all at the same time after each treatment. I took Olanzapine once a day on days 2-4 after chemo (chemo being day 1), Zofran twice a day on days 2-4 following chemo (then as needed), and Compazine every 8 hours as needed whenever I needed it. From experience, if you can keep the nausea to a minimum then your days will be so much better. My oncologist gave me a prescription for dissolvable Zofran, too, for days when I didn’t want to wait for a drug to work (mild minty flavor which was suitable to me and provided instant relief).

Expect your hair to fall out. I actually thought that I might be spared this side effect as I still had my hair during the second round, but one day my scalp was super itchy, and a few days later it was all gone. And not just the hair on top of your head, but your eyelashes, eyebrows, your nose hairs, and every place else. For whatever reason, the fine hair on my forearms stayed but everything else was gone. You can wear a wig if you want, go au naturel, or wear a cap like I did.

Your fingernails will grow darker, and will grow out weird. From experience, just expect your nails to look awful, slap a coat of polish on them, and you’ll be better for it. Mine had a strange rounding to them instead of just growing straight, were really brittle, and had these horizontal grooves in them. Once you stop with this part of the chemo, then your nails will begin to grow back normal.

Other side effects that I didn’t have that you may have: heart issues, thrombocytopenia (bleeding due to low platelets), and mucositis (mouth sores). The heart issues can happen during treatment or months to years afterward (I’m hoping I never have future heart issues because of the Doxorubicin). Use a soft tooth brush to prevent bleeding of the gums. If mouth sores do develop, avoid rinses with alcohol. You may be prescribed a special rinse to help you with your mouth sores, such as ‘magic mouthwash’. There are different recipes a pharmacist can mix up for magic mouthwash; mine was a Diphenhydramine Lidocaine Maalox mixture. I never got mouth sores, thankfully, or had a bleeding problem during chemo. But I had this concoction in my refrigerator just in case.

Side Effects of Taxol Treatment (Paclitaxel)

This drug has its own side effects, and peripheral neuropathy is the major one to be concerned about. Peripheral neuropathy causes problems with the nerves in your hands and feet leaving you with a tingling or burning sensation, or can lead to numbness to these areas. For me, it affected my feet in a weird way. It made them ‘squishy’ for lack of a better word. The bottom of my feet lost feeling periodically which made walking sometimes a challenge (I just watched where I walked). To counter this side effect, my oncologist suggested three different over-the-counter medications to try: Nerve Support, Nerve Shield, or Alpha Lipoic Acid. I took the Nerve Shield and I think it helped with my feet tingling and fingers numbing up.

During this part of chemo your oncologist will often ask you how your pinching action is, how you are at buttoning up your shirt, or even how texting is. Fine motor skills will be affected as well as your ability to grasp things. To help prevent pain to the fingers or feet, avoid really hot or really cold water, and always wear nonskid shoes. Going barefoot increases the likelihood of you stepping on something without feeling it. The effects accumulate and can actually worsen with each treatment. For the most part, all feeling goes back to normal after a period of time following the last Taxol treatment. But, unfortunately, if it gets too bad then the symptoms become irreversible, which is why your doctor will be so interested in your finger action.

You will not be as nauseous with this part of the chemo trio, but Paclitaxel calls for a whole new set of pills to take. Taxol can cause severe allergic reactions, so to limit this, I had to take 1-10mg tablet of Zyrtec one hour before chemo, 2-20mg tablets of Famotidine (Pepcid) one hour before chemo, and 5-4mg tablets of Decadron the night before and 5 more two hours before chemo. The Decadron is a steroid so a word of warning, you will be UP the night before chemo these days. I really had a tough time sleeping when I took Decadron.

Other Side Effects of ACT Chemo Treatment


You will be extremely tired and fatigued, not just physically but emotionally as well. To help counteract this, just limit yourself of your obligations. I sadly resigned as PTA Secretary (which I enjoyed) and stopped my volunteer involvement with my kids’ running club and classroom work (which I loved). It was very hard to quit before chemo when I was well, but I soon realized after chemo started that there was no way I could handle everything like I did before. As your chemo goes on, your periods of fatigue may last longer and longer. Just know your limits and try doing things to reduce your anxiety and stress levels as much as possible. If you have anemia (see below) then this may compound your fatigue.

Constipation and Diarrhea

Chemo can play havoc with your digestive system by having a negative effect on those healthy cells inside your bowels. These two things can pop up within days of each other, too. For constipation, docusate sodium is a mild over-the-counter remedy. Colace is another good medication. Eating foods high in fiber and drinking enough fluids will also help. For diarrhea, eating smaller meals for often, and making sure you drink enough fluids. Imodium AD is an over-the-counter remedy for this side effect.

Dry Skin

Your skin will be itchy and dry, so a good moisturizer will be your good friend. You have cancer and are undergoing chemo. Indulge in something nice. 🙂


Anemia is caused by low levels of red blood cells. Make sure you eat a well-balanced, protein rich diet. Dark leafy greens, beans, and peanut butter are all good choices here. Rest when you can, and often if you are anemic, and try to get at least 8 hours of sleep each night.


Neutropenia is a noticeable reduction in white blood cells. Unfortunately, this has no real symptoms until you are ill. That is why blood tests throughout your chemo course is so necessary. If your temperature goes any higher than 100.4 anytime during chemo then it is off to the hospital. My oncologist prescribed me with injectable medication to be taken at home after each round of chemo to specifically prevent my white blood cell count from plummeting.

Excessive Tearing

Your eyes will be extremely watery, and will constantly tear up. Wearing sunglasses whenever you are outside helps to protect them from the wind – which causes more tearing and watery eyes – as well as protection from the sun.

Fertility Issues

Your period will stop during this chemo concoction. Ask your doctor about menopause symptoms, which you may get: hot flashes, night sweats, mood changes.

PICC Lines: What They Are and How to Care for Them at Home

PICC line stands for “peripherally inserted central venous catheter” and it is an intravenous port inserted between the elbow and the shoulder. PICC lines are used for a variety of reasons, but in my case since my chemo concoction was a vesicant, I was required to get a PICC line installed to protect my arm and veins.

PICC lines require daily maintenance at home, weekly maintenance with your doctor or nurse, and you really have to adjust everything you do around them to ensure they are in perfect working order. But, if you are having chemotherapy, they are a cinch during treatment – you don’t have to worry about the nurses trying to find a vein every single time, and they make your lab work a breeze.

Picc Line

Typical PICC Line Components.

Installing PICC Lines

Installation for a PICC line isn’t fun, but it isn’t the end of the world either. At most, you will feel a heck of a lot pressure on your arm for the next 24 hours after it is in, but that feeling goes away. It started out with a specially trained medical professional (I had the best nurse doing mine) identifying the major veins in my left arm via an ultrasound. Once she set her sights on a vein she liked, she made my arm sterile, put a tourniquet on, and then numbed the area of insertion. This needle was actually the worst part of the procedure.

My nurse then threaded the tube from the insertion point all the way to the main vein leading to my heart via the ultrasound. An x-ray was done afterward to ensure it was placed correctly. I think the pressure that I felt in my arm for the next several hours was due to the tourniquet that was in place during the PICC line installation. The PICC line itself gave me no pain or feeling at all.

What the PICC looks like when completely installed.

What the PICC looks like when completely installed.

Care for PICC Lines

PICC lines are pretty easy to care for, really, you just need to be careful around it. You will probably come home with a clear dressing on it, like I did, that held down everything nicely. I had a mesh sleeve around it to keep it from flopping around. You will need to avoid heavy lifting on that arm, no swimming or baths, and it needs to be kept dry at all times.

Every week the dressing needs to be changed. The nurses who do this are typically highly skilled. Once the old dressing is removed, the entire area is cleaned with a cleaning solution (chlorhexidine, iodine, etc.). I was at first given chlorhexidine to clean my arm but it irritated my skin so they switched to the messy brown iodine. After it is all cleaned and the area of insertion is tended to, a clean clear dressing is placed over it, keeping the end free and clear. The injection cap is typically changed at this time, too.

Daily flushings with saline are necessary. I was given sterile plastic syringes that screwed in the end of the PICC lines to flush it. This kept the lines clear to prevent blood clots since I had chemo every other week. Oddly, at every flush, I could ghost taste the flavor of the saline. Crazy stuff. The chemo never had a taste but with each flushing, I had the odd alcohol flavor come into my mouth.

Tips for Showering

The dressing must not get wet under any circumstances. So, baths are obviously out. And unless you shower with one arm in / one arm out of the shower, you need to find a way to keep it dry. Ok, what I’m about to tell you worked wonders for me. I purchased Glad Press’n Seal plastic wrap and wrapped this around my arm. I actually used this same stuff years ago to lay on the dining room table when my kids were doing anything messy that needed a quick clean up (painting with brushes or fingers, gluing stuff on their own, etc.); I just placed this sticky side down when they worked, and then easily removed the mess when they were finished.

This plastic wrap has a slightly tacky side that gently adheres to whatever it touches. My PICC line had a dressing covering that needed to be kept dry at all times, so whenever I showered I took enough from the roll to wrap around my arm twice and pressed to stick. In the 4 1/2 months I had the PICC line in, my line didn’t get wet in the shower once with this method.

Things to Call Your Doctor For When You Have a PICC Line

The risks are low with a PICC line, and as long as it is kept clean and dry and you are careful around it, you shouldn’t have to worry about your PICC line. Having said that, call your doctor if you have major pain in your arm, have a fever, there is bleeding at the insertion point, or if the area is warm or red or there is swelling in the arm or hand of the PICC line. These are all highly indicative of an infection.


Images courtesy Wikimedia Commons through a creative commons license.