Systemic Anti-Cancer Therapy /Chemotherapy Service

Introduction

Treatment of cancer is complex and most patients find the experience daunting and the amount of information being given can feel overwhelming. To help manage this, a lot of information is provided in written format, to enable you to read and digest in your own time.

As part of the information package you will be given 4 types of information:

Macmillan Cancer backup booklet entitled ‘Understanding Chemotherapy’. This booklet provides an overview of cancer chemotherapy and also offers up-to-date cancer information, practical advice and support for cancer patients, their families and carers.

Alongside this general overview, we will give you Macmillan information leaflets outlining particular drug or drugs which will make up the treatment programme being planned. These leaflets describe how the treatment will be given and what side effects can be expected.

Our local general chemotherapy leaflet which will help you to navigate our local service and what to do when you need help and guidance.

Your treatment team will discuss your treatment plan with you face to face. In additional to this the nurses giving you your treatment will explain the information in more detail before you start treatment and give you opportunity to ask any questions that you may have.

Some patients will be offered treatment within clinical trials. In which case, a specific patient information sheet describing the trial in detail will be provided.

Useful contact information

Macmillan Cancer Support freephone 0808 800 1234.

• Macmillan Website (opens in a new tab)
• Cancer Research UK Website (opens in a new tab)

What is Systemic Anti-Cancer Therapy?

Systemic anti-cancer therapy is a general term used to describe a wide range of anti-cancer drug treatments.

Traditional drugs mainly given into a vein and aimed at destroying cancer cells are called ‘cytotoxic chemotherapy’. Other newer types of systemic anti-cancer drugs are now routinely used. These include monoclonal antibodies, immunotherapy and biological agents. A growing number of these types of drugs are also given in tablet form.

Where will I have my Systemic Anti-Cancer Therapy?

Treatment can be given to you as an outpatient, a day case or an inpatient. The location depends on the type of treatment you are receiving, how well you are and the possible side effects you may experience with the treatment.

Within the department at Addenbrooke’s chemotherapy is given in the following areas:

• As a prescription to take away with you when you attend out-patients for an appointment. You then take this medication as directed by the team caring for you.
• As a day case when you attend either the Oncology Day Unit, Haematology day unit, C9 Day Unit (for teenagers and young adults) or one of our outside ‘outreach’ GP surgeries. Outreach clinics are run by our nurses working in locations in or around Cambridge that might be easier for you to get to. Details of the locations and how to get there are at the end of this leaflet.
• Whilst you are an inpatient on either ward D9 (Oncology), ward C10, ward U3 (Haematology) or ward C9 (Teenage & Young Adult Unit).

Some treatments are given as part of a clinical trial and may be delivered in the Addenbrooke’s Centre for Clinical Investigation (ACCI)

How is my treatment plan determined?

Your specialist team will decide on the treatment options suitable for you, based on national and regional guidelines for your kind of cancer. The treatment plan will be discussed and agreed with you. The type of treatment, duration, goals of treatment, benefits and side effects will all be discussed. Your consent will be required before treatment can proceed. Your GP will be informed of your treatment plan in writing. You can ask for a copy of the treatment plan if you would like to receive it.

How is Systemic Anti-Cancer Therapy given?

Systemic anti-cancer therapy can be given in a variety of different ways including as a tablet, an injection under the skin, an injection into a vein or into the spinal area. The way we give the treatment will depend on the type of cancer you have and the treatment planned. Your clinical team will discuss with you what your treatment will involve.

If your treatment is in tablet form this will usually be prescribed for you to take at home.

If your Systemic Anti-Cancer Therapy is by injection or infusion it may be given in the day unit or on one of our wards. This will be determined by the length of time the injections or infusions take to give.

Depending on your treatment regime, you may be able to have some of your treatment at home via a pump device. Your treatment team will discuss this option with you and provide further information if applicable.

If you are to receive intravenous chemotherapy your team will discuss the type of vascular access device they would prefer to use and give you written information about long-term devices. The types of devices include:

• A peripheral cannula
• Peripherally inserted central cannula (PICC)
• Central line
• Indwelling port

Are there any side effects to the drugs?

You will be given specific information about the type of drugs you will be receiving, including their potential side effects.

Most side effects are short term and will stop when you have completed your chemotherapy. Common side effects include:

• tiredness
• nausea and vomiting
• changes in taste
• sore mouth
• hair loss
• diarrhoea or constipation
• changes in mood
• a decreased ability to fight infections
• Tingling or numbness in the fingers or toes (peripheral neuropathy).

It is important to be aware that not every drug causes the side effects listed above. You will be given information about which side effects to expect with your treatment. Your team will also give you advice and support on how to manage any side effects that may occur.

Some treatments are associated with potential long-term side effects, such as infertility. These effects will be discussed individually with you by your team before you start treatment.

Outpatient treatment

If you are having treatment in the form of tablets to take at home, you will have been given your prescription, an explanation of when to take the medication and a follow up appointment for when your team need to see you to review your treatment plan.

Day case and Outreach treatment

If you are having treatment as a day case you will be given an appointment date, which will usually be on a different day shortly after your clinic appointment.

Sometimes, if the day unit is very busy, you may experience a delay in your treatment time. If these delays are quite long you may want to take the opportunity to visit the Macmillan cancer information centre in the corridor outside of the Oncology main reception area, Maggie’s Wallace Cancer Support Centre on Puddicombe Way, or use other facilities in the hospital e.g. Main Food Hall and shopping area. Please ask a member of the nursing team about how long the delay might be so that you can plan your time accordingly.

Hot drinks and snacks are available from the RVS in the Oncology waiting area.

Treatment itself can also be quite lengthy, so you may wish to bring a book to read.

One of the benefits of treatment in the community is that patients can avoid delays often encountered in hospital. We undertake outreach treatment clinics in selected GP surgeries in and around Cambridge. You do not have to be registered at these GP surgeries to be treated there. All treatment is delivered by our specialist chemotherapy nurses. Once your treatment plan has been discussed and agreed with you, our team will contact you to arrange how and when you would like to receive your treatment. You can choose to be treated in the community, or in the hospital.

Inpatient Systemic Anti-Cancer Therapy

If you are having your treatment as an inpatient, you will either be asked to come to the Oncology Clinic first or go straight to the ward.

Regardless of which ward you are booked onto please ring the Oncology patient flow manager after 08:00, on the morning of your planned admission to check that there is a bed available for you. The number is 01223 216319.

We make every effort to ensure a bed is available for you on the day of your treatment. However, there are times, for reasons beyond our control, when this is unfortunately not possible. If a bed is not available for you when you ring you will be given instructions about what to do next. We will do our best to have a bed available as soon as possible.

If this happens to you, there may be questions you would like to ask. Please ring your specialist nurse/radiographer to discuss these.

Support & guidance

We recognise that starting treatment can be frightening so at the time of starting, you will be given details of a specialist nurse your can call for advise and support.

If you have any questions or need advice about anything, then you should call your specialist nurse and they will be happy to help.

The cancer information and support service is located in oncology, haematology and radiotherapy outpatients. The information specialist and trained volunteers can support, assess, signpost and refer. Anybody can drop in, no appointment is necessary. Tel: 01223 274801 or the Macmillan Support Line free on 0808 808 00 00.

Medication management

It is possible that you will require medication prescribed regularly during your treatment. You could be eligible for free prescriptions. To obtain this you need to complete an exemption form called an FP92A. You can get this from your specialist team, GP or pharmacist.

Advice and tips on staying well whilst on treatment

Eating and drinking whilst receiving chemotherapy

It is important that you continue to eat and drink during your treatment. Sometimes chemotherapy can cause nausea and vomiting which stops you wanting to eat or drink.

Controlling nausea and vomiting

Nausea and vomiting can be an uncomfortable side effects of systemic anti-cancer therapy. Our aim is for you to have no sickness at all. To help us achieve this we give you anti-sickness (anti-emetic) tablets to try and prevent you from being sick. Anti-emetics should be taken before you start your chemotherapy treatment.

You may be given just one or a combination of anti-emetics. It is important to take the prescribed tablets regularly as they work more efficiently as a preventative rather than a treatment once vomiting has started. It is also more difficult to keep the tablets down if you have started being sick.

If you experience nausea or vomiting, then the drugs we have given you may not be working. If this happens, please call us and we can re-think your medication. Please do not suffer in silence.

Risk of infection

While you are having treatment you will be susceptible to infection when your white cells (the regulators of the immune system) are low (neutropenic). Your white cells commonly become low seven to fourteen days after treatment, but this varies from person to person. This can make you feel extremely tired and you may find you feel the need to sleep. It will also depend on the type of treatment you are having.

Any infections you pick up during this time can make you seriously ill and you may need to be admitted to hospital to have the infection treated. Common symptoms of an infection include:

• feeling hot then cold and clammy
• shivering and shaking attacks
• a raised temperature

It is very important to contact the hospital if:

• You develop a temperature with or without feeling unwell.
• If your temperature is 38.0˚C (100˚F) or above, phone the hospital immediately.

Some patients may feel unwell without having a raised temperature. There are many possible reasons for this. One is that some medications you may be prescribed can mask a temperature.

It is important to contact the hospital for advice if you feel unwell, even if you do not have a temperature.

If you are taking medication such as Paracetamol, aspirin or steroids so let us know when you contact us as they can mask or hide a temperature. Therefore we recommend that:

• If you feel unwell or have a temperature, you need to seek hospital advice before taking any analgesics.
• If your temperature is not raised and you do not feel ill, you can take an analgesic for pain relief if needed.

Bleeding

Systemic anti-cancer therapy can also cause the platelet levels in your blood to fall. The platelets are responsible for helping your blood to clot. Low platelets levels can cause bruising or bleeding.

If you are experiencing bruising, bleeding from the gums, in the urine or stools, or have red spots or rashes in your skin, or an uncontrolled nosebleed, please contact the hospital immediately for advice. If you do have a low platelet count you should not take aspirin or ibuprofen or medications containing these drugs.

Diarrhoea

You may experience diarrhoea whilst receiving systemic anti-cancer therapy. If you are on treatment known to cause diarrhoea you will have been given anti-diarrhoeal medication to try and control this and instructions on how and when to use them. If your symptoms are not controlled after 24 hours of using regular anti-diarrhoeal medication, call your specialist nurse for advice.

Sore mouth

You may experience a sore mouth (the technical term is stomatitis) whilst receiving systemic anti-cancer therapy. If your treatment has a high risk of leading to a sore mouth you may be given mouth washes to help prevent symptoms. Good oral hygiene is essential during treatment and it is recommended to use a soft bristle toothbrush.

A small group of patients may experience some discomfort or pain associated with a sore mouth. If you experience this then let us know and we can advise you on suitable pain relief.

Constipation

Constipation can be an uncomfortable side effect of some systemic anti-cancer therapy. Our dietitians have a specific information sheet about this if you require it. The general advice they give is to drink plenty of fluid and eat high fibre food such as fruit, wholemeal bread, cereal products, such as Weetabix or Branflakes.

If the problem persists there are medications you can take and this should be discussed with your specialist nurse or your GP.

Where can I get help and advice?

You have 24-hour access for help and advice.

All patients starting systemic anti-cancer therapy will be provided with the name and contact details of a key member of staff. This is usually a specialist nurse, sometimes a Radiographer. They are sometimes described as your ‘key worker’.

Non urgent issues:

If your question is not urgent then please contact your specialist nurse during regular working hours, either using their telephone contact number.

Specialist nurses have answer phones and pick up their messages regularly throughout the working day. Please leave a message on the answer machine and this will be picked up and dealt with. If your nurse is unavailable another specialist nurse will pick up and deal with your message.

Please do not use the specialist nurses numbers in an emergency, in case they are not available straight away.

Non-Urgent issues:

Oncology Day Unit (01223 217099)

Haematology Day Unit (01223 217720 or 01223 348169)

Urgent or emergency issues:

Oncology Patients: 01223 274224

Haematology Patients: 01223 274225

After contacting the hospital, you will either be:-

• Given advice on the telephone about what to do.
• Asked to come to the Cancer Assessment Unit (open Monday-Friday), a Day Unit, inpatient Ward or the Emergency Department so that you can be assessed.
• Asked to contact your GP.
• Given arrangements for your admission to hospital if needed.

Information

If you have not received information about your systemic anti-cancer therapy and what side effects to expect or have any questions about information that you have been given, please speak to either the doctor or nurse/radiographer who is caring for you. It is very important to us that you have all the information you feel that you need, together with the answers to any questions or concerns.

It would help us if you brought any information you have been given about your treatment into hospital with you when you come to receive your treatment.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.