Queen Elizabeth Hospital Chemotherapy

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Queen Elizabeth Hospital

Chemotherapy

Chemotherapy Day Unit Guide for Rheumatology patients

Name: _______________________________________

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Telephone: ___________________________________

DOB: ________________________________________

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Hospital No: __________________________________

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If you are unwell

If you think you have picked up an infection (hot/cold, flu like symptoms, shivery, with a temperature) it is essential that you speak to someone for advice immediately. If you cannot speak to anyone on these numbers, please attend your nearest A&E department without delay

Monday – Friday 9am–4.30pm Chemotherapy Day Unit 0191 4452575 or Rheumatology Day Unit 0191 4455240 Do not leave a message on the answer phone!

Out of hours Your GP Or your nearest A&E Department

If you are unwell but have none of the above please contact:

Monday – Friday 9am-4.30pm Chemotherapy Day Unit 0191 4452575 or Rheumatology Day Unit 0191 4455240 (Answer phone 24hrs for less urgent problems)

Out of hours Your GP Or contact the doctor at the Queen Elizabeth Hospital that you were under for your initial diagnosis.

Dr J Hamilton 01914456046 Dr C Heycock 01914452198 Dr C Kelly 01914452193 Dr V Saravanan 01914456055

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Chemotherapy Day Unit

Our beliefs

The staff of the Chemotherapy Day Unit believe that our patients and their families are entitled to a relaxed and unhurried atmosphere in which treatments are given.

To have a service provided by nurses who are skilled in giving specific treatments and having the knowledge and expertise to give advice, education and support.

To work in collaboration with other members of the health care team to ensure that patient and their families are offered continuous support, advice and education, tailored to their needs.

To have an open and honest partnership where patients and their families are encouraged to participate in their care and decision making process to the degree that they determine.

To have staff who continually update their skills and knowledge and share this with their patients and families.

That all patients and their families are important, each with their own individual needs.

These are our beliefs.

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Useful information

Location

The Chemotherapy Day Unit is situated opposite A&E

Car Parking

There are car-parking facilities within the Queen Elizabeth Hospital grounds, which are "Pay and Display". Correct change is required. There is one disabled car parking space opposite the unit; alternatively there is more disabled parking within the hospital grounds.

Refreshments

The unit has its own tea and coffee making facilities, but should you require other refreshments a shop is located in the main entrance of the hospital. There is a dining room in the hospital for the use of patients and visitors, opening times are:

Sandwich Bar 10am – 11am Meals and snacks 12am – 2pm 4pm – 7pm

Smoking

Gateshead Health NHS Foundation Trust operates a "No Smoking" policy within its building and grounds.

Please do not smoke in the toilets or in the unit, as this is a fire risk.

Toilet facilities

There are 2 toilets with handrail facilities within the unit for patients. Alternative facilities are situated near the Main Entrance.

Prior to your treatment

Prior to your treatment, you will be seen by the Rheumatology Nurse who will discuss your condition and explain about the type of treatment you are going to receive and what to expect when attending the Chemotherapy Day Unit.

You will have had a blood test prior to commencing treatment and you will have your bloods checked 10-14 days post treatment. You will also have your urine checked at this time. This is discussed in more detail later in this booklet.

It is very important that you have a good fluid intake of 2–3 litres per day.

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Your day unit visit

On arriving at the day unit, you will be greeted by the ward clerk or your named nurse. For your first visit be prepared to be at the unit for up to half a day as we will wish to discuss your care with you and explain the type of treatment that you will be receiving. Your nurse will also discuss any possible side effects, which may occur.

If you wish to bring a relative or friend with you they will be made most welcome.

As this is a nurse led unit you may not routinely see a doctor unless there is a specific problem with which the nurse is unable to help you, or you ask to see a doctor.

Before you have your treatment, your height and weight will be checked (to calculate the dose of drug required). In most cases a blood sample is required prior to the preparation and commencement of your chemotherapy.

The service provided by the Chemotherapy Day Unit for the majority of patients entails a blood test, seeing a nurse and having your treatment all on the same day. Your visit time can vary from 3 hours to half a day.

Patient information

‘Chemotherapy’

‘Chemotherapy’ simply means drug treatment and is taken from two words Chemical and Therapy.

Chemotherapy treatment is provided by nurses who are skilled in giving specific treatments and having the knowledge and expertise to give advice and support.

All chemotherapy treatment is given within a specialised unit.

Most people connect chemotherapy with Cancer treatment but chemotherapy can also be used to treat inflammatory conditions such as Lupus, some forms of resistant Rheumatoid Arthritis and most commonly, Vasculitis.

Vasculitis

Vasculitis means that the blood vessels are inflamed. When part of your body becomes inflamed, it swells and is usually uncomfortable or painful. With many types of Vasculitis, you will not see any swelling on the outside of the body.

Blood vessels (tubes which carry blood around the body). There are three different types of tubes which can be affected by Vasculitis:

1. Veins – veins carry blood back to the heart.

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2. Arteries – arteries carry blood from the heart around the body and supply your body organs, kidneys, liver and your skin tissues with blood.

3. Capillaries – these are tiny vessels between the arteries and veins where oxygen and other materials pass from the blood in to your tissues.

In order for your body to function properly, our body organs and tissues need a regular blood supply, however, if the blood vessels are inflamed, this can block or reduce the blood flow.

The damage caused by Vasculitis depends upon the area of the body or organ supplied by the inflamed blood vessel.

Vasculitis in small arteries – includes Wegeners Granulomatosis, Microscopic Polyangiitis and Churg-Strauss Syndrome.

Vasculitis in small vessels can also be a result of Rheumatoid Arthritis and Systemic Lupus Erythematosis, it can also occur in different types of cancers, including Leukaemias and Lymphomas or as a result of infections such as Hepatitis.

Vasculitis in larger arteries – includes Temporal arteritis and Takayasu arteritis.

Vasculitis in medium sized arteries – includes Polyarteritis Nodosa (PAN) and Kawasaki Disease and can also occur secondary to Rheumatoid Arthritis, SLE and Sjögrens Syndrome.

Cyclophosphamide

Cyclophosphamide is a powerful treatment for Rheumatoid Arthritis, Connective Tissue Diseases and Vasculitis, and can be a life saving drug in severe cases. The use of this drug can allow the dose of steroids to be reduced if you are taking these. It is used to bring about a remission of the disease, but can take around 6 weeks or more to work.

How the treatment is given

It is usually given in treatment cycles in hospital as an intravenous infusion via a small butterfly needle or cannula, with treatment being given at intervals varying from 1 to 4 weeks. Sometimes it is given by tablet. Regular blood and urine tests are required; your Rheumatologist will advise how often these are required.

When on Cyclophosphamide, you may be given another drug prior to Cyclophosphamide called Methylprednisolone (steroids) which is given by injection (intravenously via the drip). Patients will also be on a daily dose of Prednisolone. Changes in Prednisolone dose will be made by your Rheumatologist.

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Possible side effects

If side effects occur, contact the Rheumatology helpline number given earlier in this booklet, your GP or the Chemotherapy Day Unit for advice. Calls to the Rheumatology helpline will be answered within 1 working day.

Bladder problems can occur rarely. Pain on passing water and the appearance of blood in the urine may occur. You will usually be given another drug called Mesna, which will help to prevent any side effects of Cyclophosphamide on the bladder.

Hair loss may occur but usually grows back after the course of treatment.

Fertility, pregnancy and breast feeding Cyclophosphamide may impair fertility in both men and women. This will be discussed in detail before embarking on Cyclophosphamide treatment. Women may experience irregular menstruation. You should not receive Cyclophosphamide if you are pregnant or breastfeeding. Contraception, in both sexes, is advised during and for at least three months after therapy has stopped.

Infection – Cyclophosphamide can make it harder for the body to fight infection. Contact your GP or the hospital immediately if any symptoms develop to suggest an infection. Cyclophosphamide will be temporarily withdrawn if antibiotics are required. Your Rheumatologist may prescribe a tablet called Co-trimoxazole during your treatment to decrease the risk of certain types of infection. Contact your GP or the Rheumatology Day Unit helpline immediately if you come in to contact with anyone who is infected with Chicken Pox.

Malignancy – Cyclophosphamide may increase the risk of certain kinds of treatable cancer. Your Rheumatologist feels that the benefits of Cyclophosphamide out-weigh the risks and this will be discussed with you in detail before starting treatment.

Nausea and vomiting – Many people do not suffer from sickness, but if you are one of the unfortunate ones then sickness can begin minutes after the chemotherapy is given or several hours later. Anti-sickness drugs can be prescribed for the sickness; these are best taken 30 minutes before a meal. If you continue to have problems please discuss with nurse/doctor as other anti-sickness drugs can be used.

Helpful Hints

Try taking small frequent meals every couple of hours.

Eat and drink slowly and have a rest after a meal.

If your sickness is worse on the morning try eating dry biscuits or toast before getting up.

Avoid eating or preparing food when you feel nauseous

Avoid the smell of cooking and stay away from the kitchen when food is prepared.

Try fizzy drinks instead of plain water or fruit juice. E.g. soda water, lemonade..

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The Chinese consider ginger an anti-sickness remedy. Try ginger beer or biscuits containing ginger.

Try avoiding fatty food or greasy foods, especially fried foods.

Metallic taste

It may help to suck boiled sweets or mints.

Sharp and highly flavoured foods may taste better e.g. lemon and mint flavourings, curries

Drink milk and fruit juices if you find tea and coffee taste odd

Diarrhoea – Chemotherapy drugs can affect the lining of the gut and cause loose bowel motions. This may occur for the first few days after completing the treatment. Please contact the unit or your GP for advice if needed.

Helpful Hints

Increase the amount of drinks taken.

Eat small frequent meals

Try avoiding fatty foods e.g. fried foods, cream

Tiredness – You may feel tired during your chemotherapy treatment this is quite normal, this can happen a week or two weeks following chemotherapy. It may be an idea not to plan major activities for the week after your treatment, as this is when the chemotherapy has the full effect on you. Don’t fight tiredness. Give yourself time to rest, accept help when offered especially with chores such as shopping or housework. A recent study showed gentle exercise e.g. swimming or a 10-minute walk can combat tiredness and can also reduce stress.

Special precautions

This drug does interact with Allopurinol which is prescribed for people with Gout. Remind your doctor if you are taking this drug.

It can make some anti-diabetic drugs taken by mouth more effective. In this case the dosage may need to be adjusted but you will need to discuss this with either your Diabetes Nurse or your GP depending on who looks after your diabetes.

Alcohol can be taken in moderation.

Vaccination: Live vaccines should be avoided. Flu vaccine should be given and pneumococcal vaccine should be considered.

Bone Marrow – The bone marrow is responsible for manufacturing the cells in your blood. (White blood cells, Red blood cells and Platelets.) A blood test shows the number of blood cells that are being produced by your bone marrow. Before each course of chemotherapy and 10-14 days after each treatment, a blood test will be taken. You should organise this with the nurse at your doctors

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surgery or the district nurse if you are usually seen at home. If you are registered with a Gateshead GP, ensure they mark the bloods for the attention of Rhemos (Rhemos is a special blood monitoring system for Rheumatology patients in Gateshead).

The doctor will look at your blood test results before each treatment.

White blood cells/Neutrophils – help you to fight infections. If your white count or neutrophils are low, you will be especially prone to infection. If you have a high temperature, shivering and feel unwell / or show signs of infection, contact the unit or the emergency number at the front of the book. Whilst you are having chemotherapy treatment you should avoid people with infectious diseases, such as the flu or chickenpox.

Red blood cells – carry oxygen to all the cells of the body. These may be affected by your chemotherapy and will cause you to look pale and feel easily tired. If so, do not try to do more than you feel you can, rest when you can.

Platelets – help your blood to clot. If you have a low platelet count you will tend to bruise more easily, or you have a tendency to bleed from your nose or gums. Rarely, small groups of red-purple spots may appear on your skin. Please contact the unit or your GP if any of these occur.

Advice on mouth care

In order to reduce the effects of the chemotherapy drugs on your mouth, we will offer you an ice-lolly to suck or a glass of iced water to drink, during the infusion. It is important to give extra attention to your mouth while undergoing chemotherapy. Try to get in to the practice of looking at your tongue and mouth, every day, to catch any changes in the mouth which might include mouth ulcers and oral thrush. If you have any concerns, please contact Chemotherapy day unit or your Rheumatology nurse for more advice.

Clean your mouth and teeth gently each morning and evening, using a soft toothbrush.

Use a mouthwash, but not an alcohol based, to keep your mouth fresh or if the toothpaste feels too harsh.

Natural yoghurt is good if you develop thrush, a white coating on the tongue or mouth. Your GP can also prescribe Nystatin to treat this.

Pineapple also contains an enzyme that helps soothe your mouth and tongue if it is sore.

Avoid hot or spicy foods. Dry, salty foods or acidic foods may also feel harsh.

Drinking plenty of liquids helps prevent dryness of your mouth. Some people like to drink iced water or ice-lollies.

Prevent lips cracking by using a lip balm or Vaseline.

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Cyclophosphamide treatment

Patient name: ___________________________________________________________________________

Age: __________________________________________________________________________________

Creat __________________________________________________________________________________

Creat clearance (where applicable) __________________________________________________________

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Change to Azathioprine: __________________________________________________________________

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Other medication:

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If you have any questions you wanted to ask, make a note of them here to remind you for your next visit.

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Your first course of Chemotherapy is:

PULSE DATE 10–14 DAY WCC

DOSE CUMULATIVE DOSE

1

2

3

4

5

6

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9

10

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12

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These are your blood results

DRUGS: _________________________________________________________________________________

Starting date _____________________________________________________________________________

Date Plats Neuts WCC Hb ESR Alk. Phos Gamma gt AST Creat Urine Dose

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Recorded clinic visits

DATE B.P. URINE DIPSTICK COMMENTS

Is this patient on Cotrimoxazole? Yes/No*

If no, please indicate why and inform doctor

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Is this patient on Osteoporosis treatment? Yes/No*

If no, please indicate why and inform doctor

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*delete as appropriate

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Using the following charts please keep a record of any symptoms of nausea and vomiting you experience by marking an in the box closest to your symptoms.

Nausea None Mild Able to eat and drink

Moderate Intake decreased

Severe No intake

Day of treatment

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Please show us the completed chart when you return to the unit.

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Personal Journal

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This page is for any communication from your GP or the district nurse.

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Data Protection

Any personal information is kept confidential. There may be occasions where your information needs

to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us improve the services available your information may be used for clinical audit,

research, teaching and anonymised for National NHS Reviews. Further information is available in the

leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust

website or the PALS Service.

Information Leaflet: NoIL146 Version: 3 Title: Chemo Day Unit Guide for Rheumatology Patients First Published: June 2008 Review Date: August 2016 Author: Lyndsay Thompson – Rheumatology Day Unit

This leaflet can be made available in other languages and formats upon request

Queen Elizabeth Hospital Chemotherapy

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