Introduction to Acute Oncology
Julie Skelton/Kristen Gibson
Acute Oncology Clinical Nurse Specialists
Overview of the Acute Oncology Service
Overview of cancer therapies
Primary complications/side effects of cancer treatment
Oncological emergencies Neutropenic sepsis/Febrile Neutropenia
Malignant Spinal Cord Compression (MSCC)
Superior Vena Cava Obstruction (SVCO)
MUO/CUP
Contact details
AIMS
To provide acute care to patients who have adverse complications/side effects from: their cancer diagnosis
following SACT, Targeted therapy or Radiotherapy
To provide expert advice for patient/relatives/other health professionals
Key worker for Cancer of Unknown Primary patients
To assess, plan and implement acute nursing care in accordance with local and National guidelines
Overview of the Acute Oncology Service
To liaise with chemotherapy triage nurse and other chemotherapy professionals
To analyse and react upon haematology and biochemistry results
To act as support and information source for patients and families
To act as a link between Oncologists, ED, Medical, Surgical clinicians, GP’s, patients and their families
Oncologists based at Castle Hill Hospital
Haematologists based at York Hospital
Overview of the Acute Oncology Service
Chemotherapy
Immunotherapy
Targeted therapies
Monoclonal antibodies
Radiotherapy
Supportive therapies
Cancer therapies
Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. www.cancer.gov
Tend to be better tolerated
Often given in combination with chemotherapy
Important to remember that side effects and toxicities from targeted therapies can present up to 6 months from completion of treatment
TARGETED THERAPIES (also known as biological therapies)
Rituximab..has been used for many years
Indications : NHL, CLL
Bevacizumab..Also known as Avastin
Indications : Colorectal, NSCLC, Ovarian
Trastuzumab.. Also known as Herceptin
Indications : Breast, Oesophogeal
Monoclonal antibodies
Erlotinib (tarceva) used for Non Small Cell Lung Cancer, a tyrokinase inhibitor
Sorafenib used to treat some kidney and liver malignancies
Dasatanib used for Chronic Myeloid Leukaemia
Bortezemib (Velcade) Used to treat Myeloma
Other Biological / Targeted Therapies
Epidermal growth factor (EGF) is a growth factor that stimulates cell growth, proliferation, and differentiation by binding to its receptor EGFR. Targeted therapies harness the potential of the receptor within the epiderm, hence when a patient develops a rash with treatment it is often a sign that the treatment is being effective.
Some MOABs and TKIs are targeted to the EGFR
EGFR (Epidermal Growth Factor Receptor)
Febrile Neutropenia/Neutropenic sepsis
Malignant Spinal Cord Compression (MSCC)
Superior Vena Cava Obstruction
Suspected PE/DVT
Nausea and vomiting
Diarrhoea
Constipation
Electrolyte imbalances
Hypo/Hypercalcaemia
Complications/Side effects of cancer treatment
Hypomagnesaemia
Bone marrow suppression causing pancytopenia
Mucositis
Palmar Plantar Erythema (PPE)
Rash
Pleural effusions
Ascites
Complications/Side effects of cancer treatment
Neutrophils <1
Nadir usually between 7-14 days depending on treatment regimen
Fever, but often with no other symptoms, expect rapid deterioration. Do not wait for blood results – treat!
Blood cultures must be taken; 2 sets peripherally and 1 set from any lines
Broad spectrum antibiotics within the hour;
Tazocin plus Gentamicin if severe sepsis For non-severe penicillin allergy:
Meropenum For severe penicillin allergy
Vancomycin and Aztreonam
Neutropenic Sepsis/Febrile Neutropenia
Patients advised to monitor their temperature daily whilst having chemotherapy.
For daily FBC, once neutrophils equal to or above 1
and patient is well, for discharge from hospital.
May need dose reduction or Granulocyte-Colony Stimulating Factor (G-CSF) adding to next cycle.
Neutropenic Sepsis/Febrile Neutropenia
3-5% pts with cancer 10% patients with spinal mets Compression site: 70%Thoracic 20% Lumbar/sacrum 10% Cervical
Common cancers associated with MSCC: Breast Prostate Lung Cancer of Unknown Primary Lymphoma Multiple myeloma
MSCC
Suspect it…complete a neurological examination and consider:
Is the patient known to have skeletal mets?
Worsening or new onset of spinal pain?
Nocturnal spinal pain disturbing sleep?
Gait disturbance?
Spinal pain on lying flat or on straining e.g. coughing, sneezing?
Any limb weakness/numbness/tingling sensation?
Bowel and/or bowel problems
MSCC
If suspected give stat dose of 16mg dexamethasone with PPI cover Refer to MSCC pathway:
Contact Acute Oncology CNS on 07979 645059 / 07721 444002 Request urgent MRI and obtain verbal report
If confirmed MSCC:
Patient will be referred to the neurosurgeons at HRI via referapatient.org. If accepted patient will be transferred to Ward 4 when bed available.
If not for neuro intervention; Transfer arranged to CHH, via bleep 500 and discussed with Oncology SpR on call, patient will need urgent radiotherapy.
MSCC
Most common in lung cancer patients Symptoms/signs: Breathlessness is the most common symptom (>60%) Swelling or discolouration of the face and neck Feeling of fullness in the head Bending forward or lying flat may aggravate signs and
symptoms Non-pulsatile raised jugular venous pulse [JVP] Dilated anterior chest wall and neck veins
SVCO
Investigations: Chest x-ray / CT Thorax
Treatment: Dexamethasone 16mg with PPI cover Vascular stent (not available at SGH) Chemotherapy for small cell lung cancer and
lymphoma Radiotherapy for non-small cell lung cancer
SVCO
Refer patient via 2WW
Contact Acute Oncology/CUP CNS’ to make them aware of the referral and for any advice regarding further investigations
Request urgent CT chest, abdomen and pelvis
MUO/CUP referrals
Julie Skelton – Lead Acute Oncology CNS
Tel 6236 / 07979 645059
Kristen Gibson – Acute Oncology CNS
Tel 6236 / 07721 444002
Working hours Monday – Friday 8am – 6pm
AO Contact details
Any questions?
Thank you
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