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Following is a brief overview of the chemotherapy generally known as FOLFOX followed by a table of contents of information to read as and when important to you. 

FOLFOX is the common name for a combination of three different drugs used to either eliminate colorectal cancer, to keep it from spreading, or to minimize side effects such as pain. The drugs have been combined because together they are more effective than any of the individual drugs alone. 

The Treatment

  • Treatment consists of a series cycles of infusions over time at a cancer center or a doctor's office and time such as a week until the next infusion.
  • During the time between supervised treatments, treatment continues either through a port which is inserted under the skin or through pills which are taken by mouth. 
  • Chemotherapy results do not generally happen overnight. It takes time for chemotherapy to be effective.

Side Effects

  • FOLFOX affects healthy cells as well as cancerous cells. This results in a variety of side effects. 
  • Most side effects can be controlled with other medications or self-help methods such as diet. 
  • People can generally go about all their daily activities, including work. Sometimes this takes planning.
  • Most side effects disappear over time.

How To Maximize Effectiveness Of The Treatment And Minimize The Effects On Your Day-to-day Life

During FOLFOX treatment, what you do day-to-day can work to help or hinder the treatment. Time with doctors and nurses is generally short, so there may not be time to discuss all the parts of life affected by treatment and what you can and should do about it - as well as what to avoid. How you handle the aspects of your life affected by treatment can determine how well you get through treatment and even whether you complete treatment. 

For time tested "do's" and "don'ts" about living in the new normal of treatment and recovery from treatment, we recommend that you read Life During a Continuous FOLFOX Infusion: Do's and Don'ts.

Health Insurance/Uninsured

  • If you have health insurance:
    • Learn how to maximize your benefits. 
    • Keep in mind that even with the best coverage, there is generally a large bill to be paid. Maximizing use of health insurance minimizes the amount you have to pay - and helps obtain the medical care you need.
  • If you are uninsured, or if paying for FOLFOX treatment or daily living expenses is difficult for you,  there are options to consider.


  • If you had surgery and are considering undergoing FOLFOX treatment, remind the doctor of the date of your surgery. A delay of 3 – 8 weeks is usually advised in order to assure that the chemotherapy will not interfere with healing from the surgery.
  • When you go to important meetings with doctors, nurses or patient navigators, such as the first meeting about treatment, it is advisable to take a family member or friend with you to act as a patient advocate to help ask questions and help remember what was said. Record the session if the medical professional will let you. Recording devices are not expensive. You may even be able to record the session on your smartphone. 
  • If the FOLFOX delivery method is a problem for you, ask about the form of 5-FU called Capecitabine (Xeloda.). Capecitabine is administered via oral pill instead of through a continuous pump.
  • If you haven’t decided about which of several treatments to take, and are looking for tools to help make a decision, click here. 
  • If a medication doesn’t achieve your goals, ask your doctor about other options which may be available for you including cutting edge treatments available through clinical trials. Also consider getting a second opinion from a NCI designated Comprehensive Cancer Center.

For more information about each of the above subjects, see the below links. If you are interested in all the information, please consider reading in parts. Trying to read everything at once can be overwhelming.

Life During a Continuous FOLFOX Infusion: Do's and Don'ts

During a continuous FOLFOX infusion, it is advisable to keep in mind the following does and don'ts::


Stay hydrated while receiving chemotherapy infusion to help flush the toxic drugs out of your liver. The general recommendation is that you drink at least 8, 8 ounce glasses of liquid a day. Liquid can be fruit juice, water, sports drinks, clear liquids, ice, or health drinks such as Ensure. It is preferable to minimize caffeine (coffee and tea) and only drink alcohol "once in a blue moon."

Be careful.

  • Take care of your port.  For information, including practical tips for living with a port, click here
  • Do not to break the bottle or to disconnect the connection to the port. if the infusion device leaks, immediately clamp your i.v. line and call your doctor or nurse.
  • If there is contact between chemotherapy and:
    • your skin: Immediately wash your skin with warm, soapy water.
    • your clothing and/or bedding:
      • Do not mix clothing and bedding which comes in contact with chemotherapy with your other laundry.
      • Wash all clothing and bedding that comes into contact with the chemotherapy twice.

Keep water away. Do not allow the connection or bandage between the line and the port (the "set up") to get wet. Most infusers are water resistant -- not waterproof.

  • Sponge bath: The easiest way to freshen up and avoid the set up is by taking a sponge bath.
  • Showering:
    • You can shower if you have a detachable shower head so you can wash the rest of your body while keeping the set up dry. One alternative: sit on a shower chair in the bathtub and ask a caregiver to manage your port and infuser while you wash and rinse yourself.
    • You can also shower if you cover the set up with Press-n-Seal to keep it dry.
    • Do not use hot water. Most infusers respond if your body becomes very hot or very cold.
  • Bathing:
    • You can take a bath if you place the infuser outside the tub and make sure the set up doesn't get wet.
    • One way to assure the infuser doesn't get wet is to keep it outside the tub inside a plastic, sealable, bag.
    • As mentioned with respect to showering, do not use hot water. Most infusers respond if your body becomes very hot or very cold.

Monitor the infusion flow. The infusing device should be checked to be sure the chemotherapy is flowing as it is supposed to. If your infusion is flowing slower or faster than expected, contact your nurse or doctor. Keep in mind that one of the purposes of the continuous infusion is a slow infusion. Check:

  • The indicator which shows the amount of chemotherapy which is left in the bottle.
  • That there are no kinks in the tubing.
  • The clamp on the i.v. line is not clamped and the tube is in the proper location in relation to the line.
  • That the needle is still in place in the port. You can check it by pressing down on the needle gently with your index finger. You should feel it touch the back of the port.
  • Check to see there are no leaks.
  • Also check for signs of infection. For example, redness, swelling or drainage.

Take care while sleeping when undergoing a continuous infusion: 

  • The key is to find a balance between comfort and keeping the line from detaching from the port at one end and the bottle at the other end,
  • It is generally advisable to keep the infusing device next to your pillow either uncovered or in a fanny pack, mesh "sleeve", or pajama pants pocket. Generally you will be given one of these holders at the treatment center when the infusing device is hooked up.
  • It is not advisable to place the bottle on a night table or in another area where it may fall and be damaged or break.
  • Don't be surprised if you waken at night if you roll over the bottle.
  • Try to remember to take care if you have to get up in the middle of the night and go to the bathroom.
  • Stomach sleepers may have difficulty sleeping on their stomachs because it hurts to press on the needle which is attached to the port.

Do what you can to minimize side effects. Out of control side effects are the primary reason people do not complete treatmentFor information, see: Coping With FOLFOX Side Effects

Keep all your chemotherapy treatment appointments (or check with your doctor as soon as you think you have to miss one) – and do your best to be on time.

Keep in mind that treatment decisions may change as treatment goes along.

Learn how to maximize time with your medical team. For instance, keep a symptoms diary and a list of questions to ask at your next medical appointment.  (Our prioritizer can help keep track of questions - and quickly prioritize them before going to an appointment.)

On a day to day basis, do your best to:

  • Drink a lot of liquids to help flush the chemotherapy from your system.
    • Chemotherapy is toxic. It is flushed out of the body through the kidneys and the bladder. Drinking a lot of liquids (such at 8, 8 ounce glasses of water) helps keep these organs from experiencing higher concentrations of toxic chemicals. If you need a break from water, consider clear liquids, fruit juices and electrolyte-rich beverages (sports drinks) such as Gator-Ade.
    • Drinking can be difficult if you are nauseous, and particularly if your nausea leads to vomiting. This is yet another reason to keep nausea under control. To learn how, click here
  • Minimize caffeine such as in coffee and tea.
  • Eat nutritiously for a person in treatment (which is generally different than when not in treatment). 
    • The key is a healthy diet which helps maintain your strength and keeps you from losing weight to the extent possible.
    • There is no particular diet which is recommended for FOLFOX. Instead, consider a cancer prevention diet. To learn more, click here
    • Instead of three large meals a day, it is generally recommended that you eat smaller meals more frequently. This is particularly so if you are experiencing nausea or loss of appetite.  For more information about food, click here.
    • On an anecdotal level (reports from patients rather than from scientific studies), a number of patients report that they feel better by not eating red meat while receiving chemotherapy.
    • For advice about nutrition for your individual situation, consider seeing a nutritionist/dietitian. For information about how to choose one and other practical tips, click here.
  • Practice good oral hygiene.
    • If your dentist advised you to take additional precautions during treatment, take them. For instance, your dentist may recommend a fluoride mouth rinse or a fluoride gel in addition to daily brushing.
    • An infection in your mouth can lower your body's ability to fight your cancer. Keep your mouth clean. Brush at least twice a day. Floss at least once a day. (If you haven't had one lately, schedule a dental check up). 
    • Check your mouth every day. Call your dentist immediately if you notice any changes or problems. Any of the following symptoms may indicate an infection.
      • Bleeding or a sticky, white film in your mouth 
      • Lumps 
      • Soreness 
      • Swelling 
      • Ulcerations.
      • To learn about oral care, click here. 
  • Generally take care of yourself.
    • .Take it easy. You may not have as much energy as usual, so try to get as much rest as you can. Make sure you get at least 7 to 8 hours of sleep each night. If you are having difficulty sleeping and need tips, click here
    • Do not push yourself to do too much or more than you can manage. 
      • Let the "small stuff" slide, and only do the things that are most important to you. 
      • Look for easier ways to do your daily tasks.
    • ·Consider pampering such as:
      • Take a hot bath, with or without bubbles.
      • Get a massage.
      • Go to a movie.
    • Look for humor. For ideas about bringing humor into your life, click here.
    • Consider getting a pet. Pets of any kind can provide companionship, emotional support and make you feel better. If you don't want to own a pet, you can be a foster parent for a while. Dogs provide an excuse to exercise. For information, see Pets 101
    • If you have the time and resources, consider turning your home and/or work place into a healing enviornment. .
    • Give yourself a daily "joy" break.
  • Do your best to keep a positive attitude,  To learn how, click here

Be active. Exercise to the extent that you can.

  • Studies show that many people feel better when they take short walks or do light exercise each day. Being active like this can also help improve your appetite.
  • Chemotherapy as such should not prevent you from exercising. – even if you have a port.
  • Check with your health care provider before beginning any new exercise.
  • For information about exercise, including how to keep from getting infected at a gym, click here

Be assertive about your needs. Assertiveness can be learned.

Minimize stress.

  • To learn how to avoid unnecessary stress, click here
  • To learn how to deal with stress, click here.
  • For information about dealing with holiday stress, click here 

Minimize emotional pressure by sharing your emotions 

  • People can have a difficult time physically and emotionally, particularly when treatment first starts and when it nears the conclusion.   
  • Sharing with other people in a similar situation is a great way to also gain practical information. 
  • Share emotions and feelings with family, friends, support groups and/or a cancer buddy. Seek professional help about feelings when needed. 
  • For information about sharing emotions and feelings, click here.  

Protect your skin from the sun.

  • 5-FU makes skin very sensitive to the sun, especially during a continuous infusion.
  • Wear long sleeves, long pants and a hat if possible.
  • Use a sunscreen with an SPF of 30 or greater when in the sun – even in the winter.

Stay away from anything cold - either against your skin as well as by drinking and eating for at least a few days starting with each infusion. During cold winter months, wear gloves and cover your head. It can help to carry a scarf to breath through so your lungs are not exposed to cold air. This warning is due to the side effect: senstivity to cold.

You can travel during treatment with proper planning.

  • Implanted ports do not generally set off airport security alarms. However, patients should carry the identification card they receive with the port to show to security personnel if an alarm does go off or if a full body scan is used.
  • For information about planning, and traveling, click here. 
  • For information about travel outside the United States, click here.

Keep track of your symptoms. You will be asked about symptoms since the last infusion before a new cycle starts. Keep track with our Symptoms Diary. With the click of a button, the diary is turned into an easy-to-read graph which will save the medical team time. You can use the extra time to ask questions of concern.

Call your doctor or nurse if you experience any of the Red Flags to Watch For.

Keep in mind tips for effective communication with your doctor and other medical professionals so you can use your limited time with them wisely. For information, click here.

Last but not least, lean on family and friends. To learn how, click here


As a general matter, it is not advisable to re-dress the set up yourself because of the risk of infection. Ask a nurse in the treatment facility what to do in case the bandage accidentally comes off or gets dirty.

Don't drink alcohol. FOLFOX affects the liver. So does alcohol. At least one comprehensive cancer center recommends limiting alcohol consumption to 1 – 2 drinks every 3 -4 weeks. 

If you smoke, this is the time to quit.  

  • Smoking may interfere with the effectiveness of cancer therapy. By quitting, you can improve the body’s response to treatments, lessen complications and side effects, decrease the risk of recurrence and enhance survival. Cancer patients who smoke have a lower survival rate than nonsmokers.
  • Quitting during treatment may be very uncomfortable. It may include  a variety of symptoms such as difficulty sleepingdepressionanxiety, and irritability. On the other hand, it may help keep your mind off of the treatment.
  • For information about quitting, click here

When it comes to exercise, do not:

  • Engage in vigorous exercise and activity such as contact sports during continuous infusion.
  • Swim.
  • Use a hot tub -- even with the infusing device outside the tub.
  • Enter steam rooms.


  • FOLFOX  may harm a baby developing in the womb. It is advisable not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
  • Do not breastfeed during this treatment because the drugs may come through in the breast milk.

Let a feeling of self consciousness about carrying around a chemotherapy bottle and/or pump overwhelm you.  A review of discussions in chat rooms indicates that the bottles are so small and concealable that most people don't even notice them or hear the motor if there is one. Reports indicate that people who do notice that a person is wearing a device generally "don't think anything of it.".

Do not avoid sex just because of chemo or a port. To learn more, click here.

Do not be surprised when you meet other people going through chemotherapy if their treatment schedule is different from yours. Chemotherapy schedules are tailored to the individual situation

FOLFOX and Work

While reactions to being on FOLFOX differ, the great majority of people experience extreme fatigue at some point. The more treatments, the more likely you are to experience fatigue which can affect work.

That said, most people are able to continue to work full time, perhaps with some time off for a day or two during or immediately after receiving a FOLFOX infusion.

Seeking Work

When seeking work, the first question is whether it is worthwhile looking for work now.  If you are just starting FOLFOX, if you can afford to, it is recommended that you wait until you receive the first few infusions to get an idea how you react to treatment. Once you know, you can better hone the type of job to look for, including flexibility to work around days when you may need time to deal with side effects. (It may be that you only need time off before a weekend to do the initial infusion, with the weekend for the continuous infusion).

Keep in mind that you do not have to disclose your health condition to a prospective employer, and a prospective employer cannot ask about your health.

For information about seeking work, including how to write a resume with a health history, how to rework your online presence to make it employer friendly, ace an interview, learn about an employer’s benefits and when to disclose your condition and to whom, click here.


  • Before applying for a job, it is advisable to find out what a prospective employer will learn about you by at least searching on your name through such search engines as Google offsite link, Bing offsite link, and Dogpile offsite link. If there are parts of your life that you would rather a prospective employer not know about, contact a site such as offsite link to find out what you can do..  
  • If you joined a site that relates to colorectal cancer or otherwise discusses your health condition, consider changing the name the public sees like authors sometimes use a “nom de plume” when writing a book. If this isn’t possible through the visible parts of the site, contact the web master and ask that your entries be changed or deleted so that your name no longer appears.

At Work

In theory, it is possible to work while on FOLFOX treatment and not let anyone know that you have colorectal cancer or that you are being treated for it. For example, your ability to work man not be affected if you have your infusion on a Friday afternoon, deal with the continuous infusion over the weekend, and are able to work through periods of nausea or fatigue.

On the other hand, keeping a secret is stressful. It is generally agreed that the greater the secret, the more the stress. If you are inclined to not disclose your condition to your employer and co-workers, think about why. Do you believe your employer is not friendly to people with cancer? If so, click here for help thinking through this question on an objective basis.

If you need a change at work, such as time off during or immediately after an infusion, or to be moved closer to the bathroom if you have episodes of diarrhea, or a change in work schedule or deadlines because of fatigue, or time to rest when needed – your employer may be required to provide such an accommodation due to laws such as the Americans With Disabilities Act (ADA). Under the ADA and similar laws, you must first disclose your condition in order to receive the legal protections.

If you need time off, you may be entitled to it under federal and state laws such as the Family and Medical Leave Act (which permit you to take time off in increments such as hours or days.)  If not, you can still request it as an accommodation under the ADA.

If you disclose your condition and use up all your benefits and need more paid time off, you may be able to borrow sick or vacation days from co-workers.

To learn about:

  • Who to tell, how to negotiate for an accommodation, how to maximize benefits at work, and start to be prepared “just in case” you need to stop work:
    • If you have Stage 0 or Stage 1 colorectal cancer, click here.
    • If you have Stage 2 colorectal cancer, click here 
    • If you have Stage 3 colorectal cancer, click here
    • if you have Stage 4 colorectal cancer, click here  
  • What to do before negotiating for flex time or the ability to work at home, click here
  • How to group your benefits to maximize time off with pay, click here
  • The Family and Medical Leave Act (FMLA) and similar state laws, click here
  • How to keep a Work Journal in case you ultimately need evidence because you feel discriminated against at work, click here.
  • Whether this is a time to change the balance between work and play, click here

NOTE: When treatment is over, do not expect to be back up to speed right away. Let co-workers know that isn’t reality. Try to feel confident that you can do your job again instead of feeling stressed that you don’t compare to your former self.  Take regular breaks and listen to your body. If fatigue continues, follow the coping techniques described in our article about fatigue

On Disability

While on disability, if you are receiving an income either from an insurance company, an employer or a government program such as Social Security Disability Income (SSDI) or Supplemental Security Income (SSI), your case may be subject to review to determine if you are still disabled.

It is advisable to take a few minutes to prepare for such a review by:

  • Keeping track of how your condition and FOLFOX treatment affect you on a daily basis – particularly noting the effect on your ability to do work. (You can keep track of your symptoms with our Symptoms Diary which is also useful each time you return to the treatment center for an infusion). 
  • At each doctor appointment, let your doctor know (i) about your symptoms and  (ii) how your symptoms affect your ability to work. Ask the doctor to note this information in your medical chart.  Every few months get a copy of your chart from your doctor. Check it to be sure there are indeed notes about your ability to work. (It’s also helpful to have a copy of your medical record for a variety of  other reasons, including if you need to see a new doctor or at some point you need to get a second opinion. For more information about medical records, click here.)

If you are receiving SSDI, or SSI, it helps to know your rights with respect to interviewers. For more information, click here 

If you are thinking about returning to work, before you agree to return:

  • Consider volunteering for a while to test your physical and mental abilities and stamina, and to bring your skill set up-to-date. To learn more about returning to work, including effects on benefits, click here.
  • Then think about returning to work part time to ease your way back to work..
  • With colorectal cancer, there is generally no need for occupational therapy. However, if you do need it, it is generally available and covered by health insurance.

Once you feel secure that you are able to start work, consider starting back part-time before scaling up to a full work schedule.

  • If you are receiving Social Security Disability Income (SSDI), to learn about returning to work, including trial work months and what happens if you become unable to work again, click here
  • If you are receiving Supplemental Security Income (SSI), click here..
  • If you are have a group long term disability income policy, click here 
  • If you have an individual disability income policy, click here 
  • If you want to try to return to work, click here. 

Small Business Owner

 As a small business owner, it is important to plan not only for the current situation, but also for the possible eventualities. To learn how, click here.

Self Employed

As a self employed person, it is important to plan not only for the current situation, but also for the possible eventualities. To learn how, click here.

Paying For FOLFOX Treatment

As you review the following for the situation that applies to you, keep in mind that the Colon Cancer Alliance has the Blue Note fund which provides a one time cash payment to people in need.  For information, click here offsite link.  

If you have Medicare or Medicaid (Medi-Cal in California): Both insurance coverages cover FOLFOX treatment when medically necessary. Coverage includes the infusion set up and out-patient port placement . To learn more about:

  • Medicare and life changing health conditions, click here
  • Medicaid and life changing health conditions, click here

If You Have Health Insurance:  Health insurance policies vary, but generally cover:

  • Port placement.
  • FOLFOX treatment
  • The “set up,” meaning the medical device itself.
  • Cost of infusion at the treatment center, as well as repeat visits
  • Cleansing supplies
  • Medications such as anti-nausea drugs – though you may be limited to drugs on the company’s list of drugs they cover (formulary)  Co-pays may also vary depending on whether the drug is branded or generic. 

Even if you are covered by health insurance, you may be out of pocket for a deductibleco-insurance, co-pays  or uninsured drugs or treatments. These expenses can add up quickly. In addition to the extra expense, there may be a decrease in your income as a result of your treatment. There is a reason that over 75% of the people in the U.S. who went bankrupt due to health care costs had health insurance.  To learn how to maximize use of your insurance, and minimize your out-of-pocket expenses, click here. 

If you need help paying for co-pays, contact:

  • The HealthWell Foundation Copay Program, tel. 800.675.8416.
  • For help with co-pays for fluorouracil, contact  Diplomat’s co-pay assistance program at Tel.: 877.977.9118 xt. 89864
  • For assistance with all three parts of FOLFOX, check the Partnership For Prescription Assistance website at: offsite link
  • Cancer Care at offsite link, Tel. 800. 813.4673
  • Ask the treatment center if it has a program to pay co-pays or is willing to waive them. If you are working with a social worker, ask him or her about these possiblities.
  • For additional information, see:

If you are uninsured: You may be able to obtain the chemotherapy drugs for little or no cost.

  • Oxaliplatin is manufactured by several pharmaceutical companies. Each company has its own criteria. 
    • You can find a list of the various manufacturers, and a summary of their qualification criteria at: offsite link 
    • If you do not qualify for a company’s program, it is worth a call to see if they will make an exception for you. (If you’re not good at speaking objectively about your needs, perhaps someone in your oncologist’s office or a close friend will make the call for you.)
  • For assistance with all three parts of FOLFOX, check the Partnership For Prescription Assistance website at: offsite link
  • Ask the treatment center if it has a program to provide FOLFOX to people who are not insured. If not, does it provide a discount for people who are not insured? If you are working with a social worker, ask him or her.
  • Perhaps a clinical trial is testing a particular use of one of the FOLFOX variations. You can learn about clinical trials by clicking here. Or contact a company that connects patients with clinical trials such as Emerging Med by clicking here offsite link

For information about accessing care without insurance, click here.  

You can still obtain health insurance. To learn how, click here. If all else fails, you may be able to qualify for Medicaid. Learn how by clicking here.  

If money is a concern: We have a lot of practical information about dealing with a financial crunch, including such matters as how to prioritize debt, how to negotiate with creditors, how to find money in your assets without selling them, and when to think about bankruptcy. To learn more, click here

If money is not a problem, this is a good time to do financial planning to assure that you have the financial resources to get through treatment, to continue the lifestyle you’ve worked for, and to be prepared in case colorectal cancer continues or recurs. It may be time to adjust your investment strategy to take account of a potentially shortened life expectancy.  At the same time, plan in case you have a long life ahead of you. Financial planning does not have to take a lot of time. To learn more about financial planning, click here. About investments, click here.  

FOLFOX: How Treatment Is Delivered (Infusion, Continuous Infusion)

FOLFOX is generally given by infusion in two week cycles over a period of time such as six months. In some instances, FOLFOX may be administered for up to two years.

  • Before the first cycle, a small port about the size of a quarter will be inserted under the skin which will be used by trained professionals to draw blood and for the FOLFOX infusions. The general location of the port is determined by the doctor. However, as noted in “Implanting A Port”, you do have a say about where it is placed specifically.
  • Each cycle starts with an infusion at a treatment center. The infusion usually lasts several hours.
  • Before leaving the center, an infusion device will be attached to your port permitting continuous infusion.
  • There are several different variations of FOLFOX treatment in use today. One of the variations requires replenishing the chemotherapy during treatment. In any event, the infusion device will usually be removed after 44 -48 hours. (For more information, click here.)
  • The amount of drug in each dose generally varies depending on your weight, height, blood counts, and the side effects experienced during treatment.

NOTE:  Hook-up and removal from a continuous infusion device can take place at home with a visiting nurse.  This can be particularly helpful when you are not feeling well and don’t feel like dressing and going to the treatment center.

FOLFOX and Food

Food and FOLFOX involves the right foods, dealing with eating problems that may occur, assistance with food, tips to get the most from food and drink, and avoiding infections when dealing with food.

The right foods

During treatment, it is important to eat to keep up your strength to deal with the side effects of treatment, to keep up your weight, and to help with a faster healing. 

Ask your oncologist about any changes you may need to make in your diet during treatment. If he or she doesn’t know, ask to be referred to a nutritionist/dietitian who helps people with colorectal cancer.  For information about what a nutritionist/dietitian does, choosing a nutritionist/dietician, and insurance issues, click here

  • During FOLFOX treatment, you may need extra protein and calories such as extra milk, cheese and eggs. For a list of easy to eat protein foods and liquids, click here
  • If you have trouble chewing and swallowing, you may need to add sauces and gravies.  For a list of foods and drinks that are easy to swallow, click here.
  • Sometimes, you may need to eat low-fiber foods instead of those with high fiber.

If you are already on a special diet for a health condition such as diabetes, kidney disease, or heart disease, it is even more important to speak with a doctor and dietitian. Your doctor and dietitian can advise you about how to follow your special diet while coping with eating problems caused by cancer treatment.

Eating problems

When you are healthy, eating enough food is usually not a problem. However, when you are dealing with colorectal cancer and treatment, eating can be a real challenge. There is no way to know if you will have eating problems and, if so, how bad they will be. You may have just a few problems or none at all.Your doctor, nurse, or dietitian can tell you more about the types of eating problems you might expect and ways to manage them.

If you start to have eating problems, tell your doctor or nurse right away.

For tips about eating when you don't feel like it or feel full, click here.

If you need assistance with food either because you are too tired to cook or cannot afford healthy food:

  • Spread the word among your friends that cooking may be difficult for you. Home cooked meals provided by friends have been said to have the taste of love in them.  
    • It may help if you let them know specifically what you can and cannot eat. Friends are more than willing to accommodate you. 
    • Friends can organize meals through such websites as MealTrain offsite link where you can also list foods you do and do not like.
  • Food can be delivered to your home. 
    • Commercial companies deliver ingredients for ready-to-cook meals to your home. For instance:
    • There are also delivery services that provide cooked meals.To find a delivery service in your area, check with:
      • The American Cancer Society (Tel. 800.ACS.2345)
      • A local religious or fraternal organization
      • The Department of Aging of the state in which you live. You can locate your state’s agency by clicking here.  offsite link
  • If you have difficulty paying for food, you may qualify for assistance. For information, click here

 Ways you can get ready to eat well

  • Fill the refrigerator, cupboard, and freezer with healthy foods. Make sure to include items you can eat even when you feel sick.
  • Stock up on foods that need little or no cooking, such as frozen dinners and ready-to-eat cooked foods.
  • Cook some foods ahead of time and freeze individual meal-sized portions.
  • Ask friends or family to help you shop and cook during treatment. Maybe a friend can set up a schedule of the tasks that need to be done and the people who will do them. There are web sites that make this easy to do. For example, offsite link

Tips to get the most from foods and drinks

During treatment, you may have good days and bad days when it comes to food. Here are some ways to manage:

  • Eat plenty of protein and calories when you can to help keep up your strength and rebuild tissues harmed by cancer treatment. For wasy ways to add protein to your diet, click here.
  • Eat your favorite foods on days you do not have treatment. 
  • Eat when you have the biggest appetite. For many people, this is in the morning. You might want to eat a bigger meal early in the day and drink liquid meal replacements later on.
  • Eat those foods that you can, even if it is only one or two items. Stick with these foods until you are able to eat more. You might also drink liquid meal replacements for extra calories and protein.
  • Keep a variety of protein-rich snacks available that you can eat throughout the day. For a list of nutritious snacks, click here
  • Avoid snacks that make treatment-related side effects worse. For example, popcorn can make diarrhea worse. For more information, see the section about side effects. 
  • Do not worry if you cannot eat at all some days. Spend this time finding other ways to feel better, and start eating when you can. Tell your doctor if you cannot eat for more than 2 days.
  • Drink plenty of liquids.
    • It is even more important to get plenty to drink on days when you cannot eat.
    • Drinking a lot helps your body get the liquid it needs.
    • Most adults should drink 8 to 12 cups of liquid a day. You may find this easier to do if you keep a water bottle nearby. See the list of clear liquids for other ideas.
    • Alcohol should not be included in the list of liquids to drink.

Take special care with food to avoid infections. To learn about:

  • Food safety in general, click here.
  • Guidelines for the safe purchase of food, click here
  • Guidelines for the safe handling, cooking and storage of food, click here  
  • Guidelines for eating out safely, click here  
  • How to avoid infection from food when your immune system is particularly weak, click here 


  • Many people think they can help their body fight cancer by eating certain foods or taking vitamins or supplements. However, according to the National Cancer Institute, there are no studies that prove that any special diet, food, vitamin, mineral, dietary supplement, herb, or combination of these can slow cancer, cure it, or keep it from coming back. In fact, some of these products can cause other problems by changing how your cancer treatment works.
  • Talk with your doctor, nurse, or dietitian before going on a special diet or taking any supplements. To avoid problems, be sure to follow their advice.

How Chemotherapy Works

As adults, most of the body's cells spend most of their time in a resting state. They only divide if they need to repair damage. When cells divide they split into two identical new cells. In cancer the cells keep on dividing until there is a mass of cells. This mass of cells becomes a lump called a tumor.

Cancer cells divide much more often than most normal cells. 

Chemotherapy flows throughout the body through the bloodstream and damages dividing cells. Cells in the process of dividing are more at risk of being damaged by chemotherapy.

As a general matter, chemotherapy kills the cell by:

  • Damaging the part of the control centre inside each cell that makes cells divide, or
  • Interrupting the chemical processes involved in cell division. 

For an in depth discussion of how chemotherapy works, see the American Cancer Society discusison by clicking here offsite link.

Ports: Defined, Advantages, Risks, Care Of

FOLFOX is generally infused through a port inserted in the body known by a variety of names such as a Chemo Port, Medi-Port, Medport,, Port-a-Cath or VAP (Venal Access Point).

What A Port Is

A port is a plastic or metal device, about the size of a quarter or smaller, that comes in a variety of shapes, that has a thin, flexible tube attached to the inside that is threaded into a large vein.

Purposes Of A Port

  • A port allows drugs to be administered directly into a vein while preventing damage that would otherwise occur from continuous infusion through a needle in a vein.
  • A port makes it easy to draw blood for testing purposes.
  • A port also prevents administered drugs from leaking out and hurting your skin.  

Advantages of A Port

Studies indicate that patients feel a port improves quality of life because of:

  • Decreased pain
  • Less need for needle sticks
  • Quicker blood draws.

Risks of a Port

Like all medical procedures, there are risks to be considered before agreeing to a port. Risks of using ports include:

  • The risk of damaging a vein or puncturing your lungs.
  • The risk that bacteria can access the body where it can cause a severe infection to an already weakened, immune-compromised, body.
  • A port can cause blood around it to clot which can cause blood clots or block access to the port. 
  • Dislodgement of the port.
  • Skin erosion.

Care of a Port

A port needs to be flushed periodically when you are not receiving infusions.

NOTE: If you would prefer not to have a port, CAPEOX substitutes 5FU pills for the continuous infusion and is an alternative to FOLFOX infused through a vein. If this is of interest to you, speak with your doctor.

FOLFOX Variations

The three FOLFOX variations in common usage are FOLFOX 4, FOLFOX 6 and FOLFOX 7.

FOLFOX 4, 6 and 7 vary the Oxaliplatin dose and other aspects of delivery. Two of the objectives of the variations are to reduce side effects and to improve effectiveness.


  • Day 1: in the treatment center:
    • Infusion of Oxiliplatin and Leucovorin plus a steroid, an anti-nausea medication and possibly other meds aimed at reducing side effects. If you will also receive Avastin, it will be included in the infusion. (Avastin is intended to slow the growth and spread of tumors by stopping the formation of blood vessels that bring oxygen and nutrients to tumors.)
    • 5 minute injection of 5-FU
    • Attachment of an ambulatory infusing device containing a 22 hour supply of 5-FU to a port which was previously implanted under the skin.  (An ambulatory device is a container that goes with you as you move around.)
    • You go home with the infusing device.
  • Day 2: Swap the 22 hour supply for another 22 hour supply of 5-FU. The swap either happens at the treatment center or a home nurse comes to you.
  • Day 3: 22 hours later: The pump is removed -- either at the treatment center or a home nurse comes to you.


  • Day 1: in the treatment center:
    • Infusion of Oxiliplatin and Leucovorin plus a steroid, an anti-nausea medication and possibly other meds aimed at reducing side effects. The amount of Oxiliplatin and Leucovorin varies between FOLFOX6 and FOLFOX7.
    • If you will also receive Avastin, it will be included in the infusion. (Avastin is intended to slow the growth and spread of tumors by stopping the formation of blood vessels that bring oxygen and nutrients to tumors.)
    • 5 minute injection of 5-FU
    • Attachment of an ambulatory infusing device to your port of a 46 hour supply of 5-FU.
    • You go home with the infusing device.
  • Day 2: 46 hours later: the pump is removed either at the treatment center or a home nurse comes to you.

NOTE: If you medical care at home, home health care is available. For information, including how to choose an agency, click here.

FOLFOX Side Effects: What They Are And How To Cope With Them

This article covers general information about side effects as well as specific side effects. As you review this information, it helps to keep your treatment goals in mind and to think of side effects as part of  the price that has to be paid.

Most people have side effects from chemotherapyWhich side effects will appear as well as the timing and the intensity cannot be predicted with respect to any particular individual because everyone has their own reactions to chemotherapy. That  said,  people tend to report a roller coaster of side effects which generally include those listed below, starting after the second or third infusion (cycle). 

The effects generally start soon after the chemo infusion and are at their maximum for a few days after treatment. Side effects generally continually decrease until you get back to your normal base line, which usually happens before the next treatment. 

Over time, side effects tend to be cumulative and may have a bigger impact. For example, you may get tired more easily, or it may take longer to get your energy back. Near the end of the course of treatment, you may not get all your energy back before it is time for the next treatment.

It is important to keep track of the side effects you experience because they will be reviewed before each infusion. To help keep track of side effects, we provide a Symptoms Diary


  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication. While there may be nerve damage from the Oxaliplatin that lasts beyond the treatment, all other side effects usually go away over time.
  • In some cases, side effects from nerve damage may not be reversible. Let your doctor know right away if you experience any numbness or tingling, falls or unusual unsteadiness. (neuropathy symptoms). 
  • People who have advanced colon or rectal cancer and are taking FOLFOX treatment to improve quality of life rather than with the goal of a cure, tend to experience more down time than normal time. This is thought to be due as much to the disease as it is to the treatment, but there is no scientific evidence for the cause.
  • Aggressive side effect management increases your likelihood of completing treatment. The main reason that people don’t complete treatment is uncontrolled unpleasant side effects. Also, an understanding of the most common side effects and tips for dealing with them can help avoid unnecessary physical complications and the least amount of disruption to work and everyday life.

Emotions and feelings are generally affected by being on FOLFOX treatment. For more information, click here 

With appropriate planning, the great majority of people are able to continue all activities during FOLFOX treatmentincluding travel and work.

  • For information about travel and other aspects of day to day living, click here
  • For information about work, including seeking work, at work, a small business owner and a person who is self employed, click here.


Blood level changes

  • Toxicity generally causes changes in blood levels.
    • A decrease in red blood cells causes anemia which may make you feel tired or fatigued.
    • A decrease in white blood cells lowers your defenses against infection. White blood cells serve as the primary defense against infections by destroying bacteria in the blood.
    • For some people the drop in blood levels happens on day one. For others, the low point (nadir) is between days 7 and 10. In any event, blood levels usually recover before it is time for the next infusion.  
    • An increase in elevated liver enzymes suggests changes in liver function.
  • Blood levels are checked before each infusion. 
  • A low white or red cell count still existing on the day of an infusion can delay treatment. 
  • Your doctor may administer a medication to increase red or white blood cell production.
  • NOTE: Platelet counts generally decrease after the first cycle and continue to decrease until the end of treatment when they are usually at their lowest level. Platelets help to stop bleeding.
    • Do not take aspirin, ibuprofen such as Mortin or Advil, products containing aspirin or ibuprofen, warafin (Coumadin), or vitamin E without first checking with your doctor.
    •  Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.
  • For general information about avoiding infection, click here. For the following specific situations, click on the link:


  • Diarrhea can show up as a greater number of bowel movements a day than normal (for example, 5 total movements). It could also show up as soft, loose or watery stools.
  • Diarrhea can start the day after an infusion or even several days later.
  • Diarrhea should always be treated to keep it under control. Uncontrolled diarrhea can lead to severe dehydration which results in your feeling lousy. It can also lead to kidney failure and other serious health conditions.  
  • Diarrhea can usually be controlled by over the counter medications such as Imodium.
  • Memorial Sloan Kettering advises its chemotherapy patients as follows: “If diarrhea occurs other than on the day of treatment, begin taking Imodium when diarrhea starts. Although the package cautions not to take this much, take two Imodium tablets at the first sign of diarrhea. Then take one tablet every two hours (or two tablets every four hours at night) until you have gone 12 hours without diarrhea. If Imodium is not effective after 36 hours, please call your physician.” There are prescription strength drugs available.     
    • For additional tips about controlling diarrhea, including foods to eat and foods to avoid, click here. 
  • If you have diarrhea related to chemotherapy, be sure to consume plenty of fluids to replenish lost fluids and minerals, especially electrolyte-containing beverages such as Gatorade.
  • Let your doctor or nurse know if you are having diarrhea, especially if it lasts more than 24 hours, or if you get lightheaded, dizzy, or faint.


  • The port may be uncomfortable for the first few weeks.


  • Fatigue usually starts sometime within the first few weeks after the start of treatment, adding to the fatigue that may be caused by the disease itself.
  • Fatigue gets cumulatively more intense and lasts for a while after the end of FOLFOX treatments. 
  • Fatigue is a type of tiredness that is not resolved by sleeping.  It is a tiredness in the bones and muscles that is difficult to make more bearable.  In some people, fatigue can mimic feelings of depression.
  • Even people who tolerate treatment well generally have a sense of fatigue. 
  • For tips about dealing with fatigue, click here
  • For information about depression, including the signs of depression, click here

Hair: Temporary thinning of the hair 

  • Temporary thinning of the hair can occur three to four weeks after each treatment. 
  • For tips about caring for your hair during chemotherapy, click here.

Nasal stuffiness and watering of the eyes can also occur three to four weeks after treatment.


  • Most patients experience feeling sick to the stomach (nausea) as a result of FOLFOX infusions. There is no apparent pattern as to when nausea starts, how long it lasts, or how severe it is.
  • To prevent or minimize nausea, an anti-nausea medication is generally included in the FOLFOX infusion at the treatment center.
  • You are also likely to be given a prescription for anti-nausea medication. If you don't get one, ask for it. It is advisable to fill the prescription as soon as you get it, and take the medications exactly as prescribed. It is easier to stop nausea before it starts than to wait to see if it evolves into more severe nausea or even vomiting.
    • Vomiting can lead to dehydration and other medical problems. 
    • For information about dealing with nausea and vomiting, click here.

Neurotoxicity:  Extreme sensitivity in the hands and feet, especially to cold 

  • Toxicity from Oxaliplatin affects the nerves and causes sensitivity in the hands and feet - especially to cold.
  • The effect often shows up as one of the following:
    • Your throat feels like it is closing when you eat or drink something cold. You may even feel as if you cannot breathe – but you can.
    • When you touch something cold with your hands or feet, they feel like they are on fire or you get a painful shock.
  • The effect starts during infusion and can last for 5-14 days. It gradually decreases as each day passes after treatment.
  • Patients are cautioned not to eat ice chips or drink anything cold just before treatment, during treatment, or up to 5 days after getting Oxaliplatin.
  • Beverages and foods may have to either be room temperature or heated prior to consuming. (If you really hunger for ice cream, let it melt before consuming.)
  • Time tested tips for dealing with this side effect include keeping a pair of gloves near the refrigerator so you can get what you need without touching something cold. For additional tips, click here

Numbness and/or tingling in hands and feet (Neuropathy). 

  • Neuropathy can result from Oxaliplatin.
  • One early sign of neuropathy in hands is difficulty buttoning your shirt or other tasks that require dexterity.  Another is finding it difficult to hold objects and dropping things.
  • If neuropathy starts, the dosage of Oxaliplatin might be reduced or even eliminated entirely because neuropathy can become permanent in some cases.  
  • Neuropathy from Oxaliplatin is so common that experience at one nationally known NCI designated comprehensive center indicates that only a small percentage of people who complete a 6 month course of FOLFOX still receive Oxaliplatin at the end.  
  • For information about neuropathy and dealing with it, click here.

Changes In Taste Buds

  • A FOLFOX regimen can alter taste buds. Every patient reacts differently so there is no common change. It  is not unusual for people to dislike foods that they used to love. On the other hand, it may be that foods that didn’t sit well before, become more tasteful.
  • Change in taste buds generally wears off soon after treatment ends.


Abdominal pain 

  • If abdominal pain becomes severe or continues for a few hours, contact your doctor. Abdominal pain can result from a variety of causes.
  • Be prepared to answer such questions as:
    • Is the pain throughout your abdomen or is it confined to a particular area?
    • What type of pain are you experiencing? Is it stabbing and severe? Is it a dull ache?
    • When does the pain occur?
    • Does the pain remain constant or come and go? If it comes and goes, about how long does it last each time?
    • Does the pain radiate to other parts of your body?

Burning while urinating.

Emotional discomfort or distress.  For information, see Emotions While On FOLFOX

Chemo Brain

  • While chemo brain can be generally described as feeling as if you are in a fog, it can show up in different ways. For instance, chemo brain can show up as the lack of ability to remember certain things, trouble finishing tasks, and/or difficulty learning new skills. 
  • For information about Chemo Brain, including tips for coping, click here. 


  • Some people experience difficulty emptying the bowels.
  • For information, including tips for coping, click here.  

Hand-Foot Syndrome

  • Hand-foot syndrome can include severe redness, swelling, tingling, numbness, pain and/or skin peeling and blistering of the hands and/or feet
  • Since hand-foot syndrome can lead to open wounds which can get infected, hand-foot syndrome should be treated.
  • Hand-foot syndrome is different from numbness or a tingling in hands and feet caused by neuropathy, which is described above.
  • For more information, including treatments, click here.  

Heart attack

Itching. For tips about relieving itching, click here 

Mouth sores (oral muicositis)

  • Mouth sores should be treated right away because they can lead to infection.
  • Mouth sores can also make eating difficult, which in turn affects nutrition.
  • For information, click here

Numbness of lips

Skin rash. For information about what to do about skin rashes, click here

Shortness of breath, tightness of the throat or wheezing. Report any of these symptoms to your doctor right away.

Thrush a white fungal infection that can show up throughout the digestive tract from the mouth to the anus . For information, including treatment, click here.  


 Hair Loss (Alopecia). To learn how to cope with hair loss, click here.  


  • If you experience poor sleep, you can find helpful tips by clicking here.
  • For rectal cancer, Radiation is usually given in tandem with FOLFOX.  The combination is known as ChemoRadiation. For information about the side effects of ChemoRadiation, click here.
  • If a side effect requires that you be hospitalized, read or ask a friend to read: How to Maximize A Stay In A Hospital

The Drugs Which Make Up FOLFOX

FOLFOX is a combination of two chemotherapies and a helper drug:

  • FOL” comes from Folonic Acid, better known as Leucovorin (leu-co-voor-in).  Leucovorin is  the helper drug. It is  a vitamin-like drug which makes another ingredient, 5-FU, more effective by making the effect on the cells longer lasting, usually without worsening the side effects of the other drugs. When Leucovorin is not available, Fusilev is often used as a substitute.
  • F” represents Flourouracil, commonly referred to as 5-FU  (five-flure-oh-YOOR-a-sill). 5-FU is a chemotherapy from the 1950’s which is only effective in the body for a short period of time, somewhere between 30 and 60 minutes. Because it is short acting, 5-FU is administered over a long period of time either by infusion when it is commonly referred to as 5-FU, or in pill form which turns into 5-FU when it makes contact with a tumor . The pill form is known as Capecitabine (Xeloda)],
  • "OX” represents Oxaliplatin. (ox-AL-i-PLA-tin) – a relatively new chemotherapy that is very effective against colorectal cancer cells

FOLFOX is usually administered together with:

  • A steroid to help prevent nausea and vomiting, to reduce swelling, and sometimes to increase appetite,
  • Another anti-nausea medication.  

FOLFOX is administered in several different variations. The variations are described in the section below.  The main difference between the variations is the doses of the three drugs and the ways they are given.

How To Prepare For FOLFOX Infusions

Until you know your individual reaction, it is advisable to prepare for each infusion in case you don’t feel well afterward by doing the following:

  • Ask someone to drive you to and from chemotherapy. If a family member or friend isn’t available, contact the American Cancer Society which has volunteers who will pick you up. The more notice you give the Society, the more likely you will be able to get a ride when needed. Call 800.ACS.2345
  • Work with your chemo nurse to develop a nausea plan. For instance:
    • Eat a large meal the night before treatment.
    • Take an anti-nausea pill before sleep and another in the morning.
    • Eat at least one hour before treatment - preferably foods that will minimize the effect in case you vomit. Scrambled eggs and toast are the choice for Karen B.
  • At least for the first few infusions:
    • Carry a pair of gloves in case you need to touch anything cold.  Keep in mind that it is not advisable to drink cold beverages or eat cold food for at least a few days after the infusion. See: Sensitivity To Cold
    • Keep a bucket or large plastic bag in the car and a plastic bag in your pocket or purse in case you become nauseous.
  • Wear comfortable, layered clothing with easy access to your chemoport.
  • Bring something that you find relaxing and enjoy doing.
    • If you bring music, bring ear buds so you do not disturb your neighbors. 
    • If you bring an electronic device, make sure the battery is charged and/or bring the electrical cord plus an extension cord
    • Some people find this an ideal nap time.
  • Plan time to rest after the infusion and possibly on the next day as well.
  • Prepare in case you do not feel like cooking.
    • Family and friends can help.
    • Cook and freeze in single portion containers large batches of foods you are likely to eat.
    • Freeze the food in quantities you are likely to eat when not feeling great.
  • If you have young children, line up child care. (If you haven't already told underage children about your health condition, see: Children 101
  • If you experience fatigue, plan your activities to take fatigue into account. For information about fatigue, including practical steps to help cope with fatigue in all aspects of your life, click here.
  • If you get nauseous before an infusion (“anticipatory nausea”) consider using behavioral therapies such as progressive muscle relaxation, hypnosis (hypnotherapy), self hypnosis, guided imagery and acupuncture, starting at least 24 hours before the infusion, with a last session on the morning of treatment. Behavioral therapies can be used along with anti-nausea medications such as benzodiazepines (Xanax or Ativan.) 
  • Ask for a prescription for a medication such as Emla or Lidocaine cream to place on the skin over the port prior to injection to numb the skin from the needle insertion. If you put the medication over the port before heading to the infusion facility, you can cover it with a temporary covering such as Press-n-Seal, or plastic wrap, to keep the cream in the right place, and to prevent it from getting on your clothes.

NOTE: Be sure to keep track of symptoms and reactions on a daily basis so you can report accurately each time you go to a medical appointment. We supply a Symptoms Diary to help you keep track. To learn more, click here

Implanting A Port

Where A Port Is Placed

A port must be near a large vein that goes into your heart - generally the superior vena cava vein directly above the heart. The port has a little tail (a catheter) which is stitched into the vein.  Any medication infused into the port goes directly into the heart. From there it is pumped throughout the body.

While the surgeon will pick the area near a blood vessel where the port has to be placed, you can generally tell the doctor where you want the port for comfort and perhaps for appearance. For example:

  • A woman may want the port inserted above her normal bra line to prevent chafing, or closer to the shoulder so the port (and ultimate scar) doesn't show through many tops.
  • Men may not want the port visible when the top button of a shirt is open.

It is advisable to not get too hung up on the placement of the port. It may be easier to think of it as one of the modern medical miracles that is being put in place to save your life.

Implanting A Port

  • A port is implanted under the skin (subcutaneously) in the upper chest, but it can sometimes be placed in the arm.
  • Port implanting happens through a minor surgical procedure which is performed on an outpatient basis with continuous sedation  much like the one used when you got a diagnostic procedure such as a colonoscopy. The patient never loses consciousness. For information about outpatient procedures, click here.
  • The procedure is so minimal that people are usually able to engage in social or other activities the same night although you may need to ice the incision area for comfort before going out and as soon as you return.

Choosing The Surgeon To Insert A Port

Generally the surgeon who implants a port is chosen by the treatment center.

If you have a choice, ask the nurses at the treatment center which of the surgeons has the most experience installing ports who has consistently has a high success rate. Choosing the best available doctor helps to minimize the chances the port doesn't work and that it has to be removed and reinserted. To learn more about choosing a surgeon, see Choosing A Surgeon.

What Happens During a Continuous FOLFOX Infusion

After infusion in the cancer treatment center:

  • A small container (usually a plastic bottle) filled with 5-FU will be attached to your port via an i.v. line.
    • There are two types of containers: those which are self contained and those with a pump attached. Which type you receive generally depends on the practice at the cancer treatment center.
    • Self contained containers rely on your internal body temperature and pressure to draw the chemo through the i. v. line and into your port.
    • Pumps are generally noiseless.
    • The container (and pump) is usually provided in a fanny pack or other case to make it easy to carry. 
  • FOLFOX will be continuously slowly infused into your system through your port.  
  • Patients generally report that there is no pain or discomfort during a continuous FOLFOX infusion.
    • If you are undergoing FOLFOX 4, you will swap the 22 hour supply for another 22 hour supply.
    • If you are undergoing FOLFOX 6, the infusion continues for 46 hours - 48 hours.

Disconnecting The Set Up At The End Of Each Infusion

  • The infusing device will indicate when it is empty.
  • When the infusing device is empty, it must be disconnected from your port.
  • Disconnecting the infusion device is a very simple procedure, but must be done correctly.
    • First the line and port are flushed with a saline solution, then with an agent to keepthe port from clotting such as heparin. It takes about two minutes to flush the tubing.
    • Then the needle is pulled out. According to an experienced oncology nurse, it takes a quick, smooth movement.
    • The disconnecting process should be covered with a drape to prevent chemo medication leaking which can be painful to the skin. 
  • It is generally recommended that the first disconnection be done at the treatment center so you or whoever will remove the set up can be supervised while doing it.  After that you can be trained to do the disconnection yourself, you can have a family member or friend get trained to do it for you, or you can return to the treatment center for a nurse to take care of it for you.
  • The container should either be returned to the medical facility for proper disposal during your next visit, or you should dispose of it at a facility that disposes of bio-hazard material.

For information about living during a continuing FOLFOX infusion, click here.

What Happens During FOLFOX Infusion At The Treatment Center

Each FOLFOX treatment starts at a cancer center or doctor's office. 

Before the drugs are administered, medical staff will:

  • Ask about side effects you experienced since the last infusion. (Keeping a Symptoms Diary or at least a handwritten journal, helps keep track accurately).
  • Ask if you have any questions you or your caregivers have. (Keeping notes in our Prioritizer helps remember questions. Before a meeting, you can prioritize them with a push of a button).
  • Do a blood draw either the day before infusion is scheduled or the day of the infusion to be sure the port is functioning properly and to check blood levels such as red and white blood cells, platelet count and liver function.
  • Check vital signs such as body temperature, pulse, and blood pressure.
  • Possibly check other indicators.  
    • NOTE: Tell your doctor and/or nurse about ALL side effects you experience and their severity. Side effects may indicate a problem that only the medical team can assess. Keeping symptoms to yourself or underreporting them is dangerous to your health. If a treatment is given when your body is not at optimum health, problems may result to the degree that you end up in the hospital. 
  • There will be a wait while the medical team gets your blood results. (The wait can be anywhere from 15-20 minutes to several hours, depending on the lab and how busy it is,)  You will then meet with at least one member of your medical team.
    • This is the time to discuss coping with side effects and what can be done about side effects going forward.
    • This is also the time to discuss any other matters that may concern you.
  • A medical decision will be made whether to proceed with the planned treatment, whether the dosage of the various drugs need to be varied, or whether the treatment needs to be postponed.

If the treatment proceeds as planned:

  • The nurse will set up the infusion. The port will be washed out with saline solution and with a blood thinning medication such as heparin.
  • It is advisasble that you the patient, or a patient advocate with you, review the premeds and infusions prior to hookup to insure that the correct medications and dosage are being administered. No matter how competent your team, mistakes do happen.
  • Oxaliplatin and Leucovorin are usually delivered together (infused) over a period of two hours. Pre-medications may include a steroid to prevent swelling and nausea, and a medication to minimize nausea. 
  • After the infusion, you will be given a bolus injection of 5-Fu (“bolus” basically means a fast injection.)
  • If you are not feeling well after the infusion, do not leave the treatment area. Tell the medical staff.

Side Effects During The Infusion of FOLFOX

You may feel cold during the initial seconds of the infusion. This feeling rarely lasts more than a few seconds.

Since steroids and anti-nausea medications are usually included in the pre-medications before the infusion at the medical center, people generally feel okay while being infused. In fact, the steroid may make you feel somewhat energized.

It is not unusual for neurotoxicity and nausea to start while drugs are being infused in the treatment center or as soon as the patient walks out of the treatment center. Neurotoxicity is extreme sensitivity to cold and is likely to last for 4 or 5 days in the hands, feet, and mouth. For tips about dealing with neurotoxicity and nausea, see Side Effects

Before leaving the treatment facility:

  • A continuous infusion device will be attached to your port. For information, click here.
  • You will be given a prescription for anti-nausea medication.
    • It is advisable to fill the prescription right away.
    • it is critical to take the pills as prescribed. 
    • Do NOT wait until you feel queasy or nauseous.  It is easier to stay ahead of the nausea than to try to stop it once it starts.  (For information about medications to take outside the medical setting, including purchasing, storing and disposal, as well as insurance coverage, click here.) 
  • It is recommended that you stop in the bathroom before leaving the treatment center to avoid the possibility of having to stop for an urgent need to urinate on the way home.

Side Effects Immediately After FOLFOX Infusion

The majority of patients report feeling sluggish the day the bottle is removed and during the next few days after that. You may also feel irritated while coming off of the steroid. (To help cope, see Emotions While On FOLFOX)

What NOT To Do While On FOLFOX Treatment

Avoid alcohol, cocaine and other recreational drugs which affect the liver.

  • The liver is already under stress from processing the toxicities from the chemo. 
  • If you don’t eliminate alcohol entirely, it is advisable to at least limit alcohol consumption to only occasionally. For example, a glass of wine every 2 to 3 weeks. 
  • Keep in mind that your liver function will be checked before each infusion. If it is not up to par, the dosage may be reduced, or the infusion may be postponed. An inflamed liver can lead to hepatitis or other serious health conditions.

Do not:

  • Start taking any new medicine (over-the-counter or prescription), herbal remedies, vitamins or dietary supplements without checking first with your doctor.
    • Some of these may interfere with your chemotherapy.
    • Aspirin, NSAIDs (such as Advil or Motrin) and vitamin E can add to bleeding problems. Ask your doctor or nurse what you can take instead.
  • Take any vaccination without checking with your doctor first.
  • Color your hair.
  • Cover your nails with polish that prevents a medical professional from seeing skin color and a nail bed. Your nails will be examined before each infusion as a sign of side effects. If colored polish is important to you, your doctor may permit you to color your nails so long as you leave part of one without colored polish.
  • Touch or ingest a cold beverage or food, or touch anything cold, for a few days starting with infusion. For additional information, see: Sensitivity To Cold

Red Flags to Watch For While Undergoing FOLFOX Treatment

Call your doctor or nurse if you:

  • Have a fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.
  • Have more than five loose bowel movements a day.
  • Have any sign of bleeding. This includes in your bowels (black bowel movements), bruising of the skin, a faint red rash, and other signs of bleeding.
  • Develop mouth sores.
  • Have difficulty breathing, chest pains or other symptoms that could indicate a heart attack.
  • Have any form of an allergic reaction such as facial swelling.
  • Have any unexpected or unexplained symptoms.
  • Have any questions or concerns.

Living With A Port When Not Being Infused

  • Wearing a port has been reported to be uncomfortable - particularly for the first few days or weeks until you adjust to it. 
    •  Power ports tend to stick out a bit further from the body and may take more getting used to. 
    • Wearing a port is not painful for most people.
  • Ports need to be flushed with a special solution during treatment and every 4 -- 6 weeks when not in active chemotherapy treatment. 
    • Flushing is usually performed with a combination of a saline solution and a blood thinning drug such as Heparin. 
    • The nursing staff will usually perform necessary flushing during treatment and can show you how to do the flushing yourself at other times.
  • Women: the weight of breasts and gravity can put strain on a port.
    • If you feel a strain, consider wearing a supportive bra while awake - at least during the first month after the port insertion.
    • "Sleep bras" help minimize pulling at night. (They can also generally be worn during scans because they do not have any metal in them.)
  • When a continuous infusion is in progress, care must be taken when washing and sleeping. To learn more about life with a continuous infusion, click here.
  • When not being infused, you can do all activities with a port, including swimming and contact sports
  • If you have questions about any activity that is part of your life, ask your medical team "just in case."

How Long A Port Stays In Place

A port can remain in place for as long as your doctor determines that you need it -- to a maximum of the port's expiration date. Over time, the port  generally moves closer to the surface of the body.

Removal of A Port

Ports are generally removed in an out-patient procedure while the patient is under conscious sedation.

  • The removal is generally done in an out-patient setting instead of a doctor’s office because there could be serious complications if something goes wrong.
  • If your insurance company does not approve of an outpatient setting, consider filing an appeal. To learn how to appeal a health insurance claim, click here.

When a port is removed, there will usually be a small scar that can be unattractive for a few months until it heals.

  • Eventually it will look like a small line.
  • If the scar is a problem for you, it can removed with plastic surgery or covered with heavy makeup or a tattoo.
  • Some people tattoo a symbol of their disease over the scar as a badge of survivor honor and to remind them how lucky they are to be alive.

The casing that the port sits in generally remains in your chest. Despite the casing, there may be a hollow spot or indentation where the port was inserted.

If you want to keep the port as a souvenir, ask the doctor before the removal takes place.

NOTE:  Before proceeding with a port removal, consider your insurance situation. If you used up your deductible in a year, the port will be removed at minimal cost to you. If you haven't used the deductible, consider postponing the surgery until there is a year with necessary medical expenses that use up the deductible. For more information, see our information about Maximizing Your Health Insurance Policy by clicking here.

Nearing The End Of FOLFOX Treatment

Expect that side effects such as fatigue will be cumulative. If this happens, keep in mind the goals of the treatment – and that you are nearing the end.

Also think about:

  • A treat to give yourself when treatment is finished.
  • Doing something to thank the staff at the treatment center.
  • Thanking your support team. A handwritten note is nice to receive. Or send an e-mail or pick up the phone. Everyone likes to receive acknowledgement.

It is usually advisable to leave the port in place for a minimum of a year after the end of treatment until your doctor can assess the results of treatment. If you do not need further chemotherapy, it may still be worthwhile to keep the port in place until you are reasonably certain that you will continue to be "NED" - no evidence of disease. Oncology nurses report that a second port rarely works as well as the first, although for some patients a second port may work better than the first one.

Ask your doctor for a cancer follow up plan which includes a list of future appointments to keep, tests to have and symptoms to watch for.

  • Share the follow-up plan with your primary care doctor. 
  • Do your best to show up for all scheduled appointments. 
  • For information about a cancer follow up plan, click here.

For information about life during the recovery period after treatment.  Click here.  

Recovery From FOLFOX Treatment

While cancer treatment has officially ended, the after effects will likely continue at least during this recovery period. This section of our guide provides information to help you thrive in the parts of your life affected by your treatment.

To maximize the benefit of our information to you, we suggest the following three steps:

  • Step 1. Even if you have read the parts of our guide concerning Newly Diagnosed, we suggest that you review “The Basics” because they are the foundation for all of our discussions.
  • Step 2. Read about managing your medical care. Our medical care article describes how to start on a track to make the future better.  Part of medical care is to start living a healthier lifestyle such as a cancer prevention lifestyle which includes a focus on nutrition and exercise. Food is particularly important to the incidence of colorectal cancer.
  • Step 3.   At  least look at the summaries of each of the following articles to see how they apply to your life. Press the back button on your browser to return to this article and to move on to the next summary. You can return to each subject if and as it works for you. Alternatively, you can sign in and then bookmark this page.  

While information can help you feel in control, too much can also be overwhelming. If you begin to feel overwhelmed, take a break and return when you are ready to learn more. Or ask someone else to review a particular subject for you. Keep in mind that family and friends want to help even after treatment ends.

Life After FOLFOX Treatment: Long Term

The first two buttons below refer to Post Treatment Six Months Plus with No Evidence of Disease (NED in technical parlance). If one of the next three buttons applies to you, click on the appropriate button


Long Term: Stages 0,I

Long Term: Stages II, III,IV






Nearing End Of Life


Your Health Care Team

The medical team that you are likely to meet  when undergoing FOLFOX treatment generally includes the following people::

Medical Oncologist –  A medical doctor who diagnoses and treats cancer with chemotherapy, hormones, biologicals or immunologic agents. A medical oncologist generally coordinates treatment provided by other medical specialists.  

Nurse A person who is educated and trained to care for people who are sick or disabled. Nurses can be a valuable source of practical information. Nurses are generally the people who will ask patients for information about what happened since the last infusion, who will take the necessary blood tests, and connect, supervise and disconnect the infusion.

Nurse Practitioner A nurse who has received special training who can perform many tasks customarily performed by a doctor. For example, a Nurse Practitioner can treat certain routine or minor ailments without the direct supervision of doctor.

Patient NavigatorThere is no standard definition of Patient Navigator. As a general matter, a Patient Navigator is a person who helps overcome barriers to medical care by anticipating and resolving a patient’s problems.  For current purposes, a Patient Navigator assists patients through the course of treatment. For instance, by scheduling appointments, providing information, support and encouragement

Social worker - A Social Worker has an education and experience in providing social services. As a general matter, a Social Worker can answer questions about programs which are available to pay for treatment and can help answer the practical questions you may have outside the medical arena. A social worker can also provide assistance with emotions and feelings.

Family and friendsare people who should also be considered part of your health care team. For more information about the concept of a team, and how to be the captain of the team, click here 

Emotions And Feelings While Undergoing FOLFOX Treatment

The cancer experience, and particularly while going through treatment, is an isolating experience during which people tend to feel separated from family and friends.

  • Depression and emotional stress are common while on chemotherapy – particularly when experiencing side effects such as nausea, infection and neuropathy that affect your quality of life. In fact, depression and emotional stress often affect a patient’s ability to manage chemotherapy.  Patients who become depressed are more likely than others to consider stopping treatment. To learn the signs of depression, click here.
  • Fears of the future as well as fear of the toxic side effects of treatment are also common.
  • Although fatigue is a physical symptom, it often feels like an emotional state as well. For coping ideas, see the discussion about fatigue..  

Share your emotions. As a general matter, a major help for dealing with emotions is to share them with other people and to express them by keeping a journal or creating art that reflects the experience you are going through. 

Possible ways to share with others include the following:

  • Talk with someone you trust about your feelings.
  • Join a support group of other colorectal patients or survivors of other cancers. Support groups meet in person, on the telephone or on line. This can be a way to meet others dealing with problems like yours. In support group meetings, you can talk about your feelings and listen to other people talk about theirs. You can also learn practical information such as how others cope with cancer, treatment side effects, and eating problems. For information about colorectal cancer support groups, click here.
  • Connect with a cancer ‘buddy’ who has gone through treatment or is going through it. For information about colorectal cancer buddies, click here. You can meet a cancer buddy through an organization such as Colon Cancer Alliance offsite link 
  • Seek professional help. For information about choosing a mental health professional, click here.
  • Talk with family and friends. 

A 1999 study conducted by the Oncology Nursing Society and Amgen, Inc. found that most people who had difficulty emotionally coped by using prayer and getting help from family and/or others who had also gone through chemotherapy.

  • For information about support groups, including why to join and to find one that works for you, click here.
  • To learn about cancer buddies and how to locate one, click here.

Deal with emotions that surface with activities such as relaxation techniques, meditation and prayer. For information, see: Tips to Help Feel in Control of Your Emotions.

For information about coping with the following feelings/emotions, click on the link:

NOTE: Expect mood swings.

  • You may feel as if your emotions are out of control at times, including suddenly crying about minor things. On the other hand, you may feel high or euphoric which could be because of one of your medications.
  • There may be other mood effects from particular drugs which are taken to lessen side effects. For example, steroids are usually accompanied by a feeling of euphoria, often followed by irritability, sleeplessness, moodiness or depression.
  • The emotional seesaw will pass.
  • Simple things often help such as a warm bath (making sure not to get an infusion wet), listening to soothing music, exercise, muscle relaxation, creative visualization or meditation.
  • If mood swings become too difficult to bear, ask your doctor for assistance. There may be medications available, or professional help may be recommended.
  • As Dr. Jimmie Holland stated in THE HUMAN SIDE OF CANCER: “It’s important to recognize that these moods are signs of the brain’s biochemical reactions to drugs. They do not reflect failure on your part to cope with cancer, nor are they a sign of mental illness. You are fine – it’s what the medicines are doing to you.”

Disability Income From SSDI and/or SSI Or A Private Insurer

If you are not receiving disability income 

If your colorectal condition or ongoing FOLFOX treatment keep you from working, you may be entitled to an income from Social Security Disability Insurance (SSDI) and/or Supplemental Security Insurance (SSI) or another government program. 

If your cancer has metastasized (spread to other organs or elsewhere in the body), you may be entitled to what is referred to as a fast track determination that you are unable to work. Otherwise, you will be subject to an extensive, time consuming, review. Only one third of the people who apply for SSDI are approved for benefits. We provide practical information about helping you apply that increase the chances you will be approved. For instance, we recommend that you apply in person, not online to learn more, click here.  

If you are receiving a government disability income benefit, plan in case a check is done to see whether you still qualify for an income benefit. To learn more, click here 

If you are receiving a disability income from an insurance company or an employer, click here.

FOLFOX and Sex

Both sexes

  • During a continuous infusion of FOLFOX, the infusion itself is no reason to avoid sex – just be careful not to disturb the set up. 
  • In addition to the normal fatigue and lack of interest that may be caused by your treatment, your body and self image have likely been altered due to colorectal cancer. Physical changes can affect how others react to you, which can affect your body image. Not everyone knows how to react ot people who have had cancer or who have physical changes from cancer or its treatment. Some people will react negatively, and that can cause hurt feelings and discomfort. Having a strong, positive body image may help you worry less about how other people react to your physical appearance. For tips about coping with a changing body image, click here.
  • Let your spouse or partner know how you feel. Ask your partner to do the same. 
    • A partner's concerns or fears also can affect the sexual relationship. 
    • If either of you wants more information about sex, speak with your doctor and/or nurse. 
    • If it is hard to talk to each other about sex or cancer or both, consider talking with a mental health counselor who can help the two of you communicate more openly. For information about choosing a mental health counselor, click here
  • Other forms of intimacy, such as cuddling, are a good substitute during this period of time. For information, see Sex and Intimacy.
  • If you are undergoing radiation or surgery, avoid contact with sensitive areas.
  • If you have an ostomy, click here for tips about having sex. 

Even if you are not interested in sex, it couldn’t hurt to let the other person know you still find him or her sexy.


  • Chemotherapy  may lower the number of sperm cells, reduce sperm cells' ability to move, or cause other changes. These changes can result in short- or long-term infertility. Infertility affects a man's ability to father a child, but does not affect his ability to have sex.
  • Men who are getting chemotherapy should use birth control during treatment because chemo may have harmful effects on chromosomes of sperm cells. Ask your doctor when you can stop using birth control for this reason.
  • If you are reading this before undergoing chemo, consider banking sperm if you want to have children in the future. To learn more, click here 


Chemo can damage the ovaries and reduce the amount of hormones they produce. As a result, a woman may have the following side effects:

  • Your menstrual periods may become irregular or stop completely during treatment.
  • You may have menopause-like symptoms, such as hot flashes and itching, burning, or dryness of vaginal tissues. These tissue changes can make intercourse uncomfortable. The symptoms often can be relieved by using a water-based vaginal lubricant.
  • You may become Infertile (unable to become pregnant). Whether this happens and how long it lasts depends on many factors, including the type of drug, the doses given, and your age. It is important to discuss this possibility BEFORE you start treatment.

NOTE: Women: You may be more likely than normal to get vaginal infections. To help prevent infection:

  • Avoid oil-based lubricants such as petroleum jelly.
  • Always use a condom for sexual intercourse 
  • Wear cotton underwear and pantyhose with a ventilated cotton lining
  • Don't wear tight slacks or shorts. 

Your doctor also may prescribe a vaginal cream or suppository to reduce the chances of infection. If you do get an infection, it should be treated right away.

For information about couples, click here

If You Have Advanced Colorectal Cancer

If you have advanced colorectal cancer, it is likely that you are undergoing treatment with FOLFOX to keep the cancer in check and/or to relieve pain rather than seek a cure.

Studies indicate that doctors by and large do not initiate the conversation about whether, and, if so, when, to stop treating the disease and instead focus on quality of life. Rather, it is up to the patient to bring up the subject.

If this is a subject that is of interest to you, we have created a list of factors to consider to help you decide what you want to do, and when. Thinking about the factors one-by-one can help minimize the emotions involved in even a discussion about this subject, much less a decision. For more information, click here

When you have time, it may also be helpful to read our Guide about Living with Advanced Colorectal Cancer

If Treatment Is Not Working

There are likely other treatments to consider. Discuss alternatives with your doctor.

If your situation is unusual, also consider researching other treatments yourself or ask a family member or friend to do it for you. Alternatively, you can hire a medical research service

  • For information about medical research and how to do it, click here.   For information about medical research services, click here.
  • Watch for quack treatments. To learn how to spot a phony treatment, click here. 
  • Discuss what you find with your doctor. 

Consider getting a second opinion from a qualified, experienced specialist who is not connected with your doctor – preferably from a doctor who is with an NCI designated Comprehensive Cancer Center offsite link.

  • Doctors are used to a request for a second opinion. The ask in this situation is certainly understandable.
  • A second and even a third opinion will likely be covered by your health insurance. If you do not have insurance, second opinions do not have to be expensive.
  • To learn how to get a second opinion, click here.

A consultation with a doctor who specializes in treating pain (a palliative-care specialist) can help. Such professionals are trained to consider the patient’s entire medical and personal situation and to focus on symptom management and pain relief along with curative treatments. For information,see:

If the prognosis is particularly worrisome or the cancer does not respond to aggressive measures, consider modifying treatment to preserve your quality of life. For information about factors to consider, click here

If it looks as if you have a shortened life expectancy of six months or less, consider hospice care. Hospice care can be given at home – and can be free if necessary.

FOLFOX Family and Friends

If you have a spouse or partner: Living with someone undergoing chemotherapy treatment can cause distress due to intensity of emotion, anxiety and the possibility of an unpredictable illness. The key is to share your feelings.

  • Holding back your emotions hurts both people in a relationship.
  • Rather than share all emotions the moment they surface, consider the time and place. Then share at what seems like the appropriate time.
  • For information about sex, click here.

Allow family and friends to share their emotions. Treatment is difficult for them as well.

  • Keep in mind that emotional stress for a caregiver is often based on the fact that he or she wants to cure you, but can't. What a caregiver can do is care. Caregivers need to be reminded how essential and important caring is to you.
  • Let family and friends know that there are support groups just for caregivers. To learn more about support groups, and how valuable they can be, click here. 

If you have young children – Do not try to hide either your diagnosis or your treatment. Children will know something is up and are prone to thinking that they caused the problem if no one talks about it. Instead, involve your children so they get a feeling they are helping. To learn more about:

  • How to disclose your health condition to your children taking their age into account, click here 
  • How To help children cope. Click here 
  • Getting care for children if you are unable to care for them. Click here 

If you have older children: Research indicates that children of all ages do not like the parent to talk about the futility of the disease and the possible failure of chemotherapy to cure the cancer. They have difficulty coping with parents who have little hope or who have negative outlook. Children wrestle with the possibility of separation during a parent’s illness. Apparently the feeling of imminent death of a parent is heightened during chemotherapy. 

Friends: Research indicates that support from friends is highly valued.

  • Many people report that they feel better when they ask for or accept help from others. it is worth noting that family and friends generally feel better when they have something they can do to help you.
  • They are a good source for sharing emotions and to motivate people to continue to socialize during treatment. 
  • To learn more about treating family and friends as part of your health care team, click here.