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Oxford University Hospitals NHS Foundation Trust
Clinical Haematology

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Chemotherapy

Chemotherapy is the treatment of cancer with drugs. These can be given as tablets, or by injection or in a bag of fluid given into a vein over a number of hours. This is called an intravenous (IV) infusion.

Understanding and consenting to your treatment

The treatment team will discuss with you what the treatment will involve, the possible side effects, the benefits and the risks. It is important that you understand the information you have been given, and that you ask questions if you don't understand or if you want more information.

You will be asked to sign a consent form, which is a written record that you have agreed to the treatment and that you give your permission to proceed. You may withdraw your consent at any time.

The dose of chemotherapy is planned specifically for you depending on your weight and condition. At your outpatient appointment the team will confirm your height and weight and you will have been given instructions and blood test forms needed before you start treatment. You will need to visit your GP surgery for these initial blood tests, which should be done 24-72 hours prior to chemotherapy.

Pregnancy

Female patients of child-bearing potential must be aware of the importance of not becoming pregnant at any time throughout a course of chemotherapy. If you think you may be pregnant at any time during your treatment please tell a member of staff as soon as possible. All female patients within this age range will be asked to have a pregnancy test before their first course of chemotherapy.

Male patients must use appropriate contraception to prevent their partner becoming pregnant during their chemotherapy and for at least three months after.

Preparing for Chemotherapy

PICC, Hickman or Portacath

Some patients who need certain types of treatments that can irritate smaller veins, or who need treatment over a long period of time, have a special catheter or hollow tube put into a vein in the arm, usually above the elbow or chest. This is called a PICC, Hickman or Portacath depending on the type of catheter. This stays in place for the duration of your treatment. This can be put in on a separate appointment or on day one of your first treatment.

At your first appointment in DTU your nurse will spend some time with you discussing with you the process of the treatment, the possible side effects after treatment and how to cope with these. They will also review your blood results and ask how you have been since the outpatient appointment, to ensure that you are fit to have the treatment.

Many patients will need to see a doctor one to five days prior to each treatment in the Outpatient Clinic.

You can make this appointment at Outpatient Reception before you leave DTU, or ring the Appointment Line when you get home.

  • Appointments: 01865 235185

This clinic doctor review will allow you to discuss any problems from your chemotherapy (physical and/or emotional) and assess your recovery from the previous treatment. It is about your individual needs, an opportunity to obtain information, support and referral to other services as appropriate.

If you have not received an appointment by one week after chemotherapy, please ring the Appointment Line or your Consultant's secretary.

At each treatment appointment in DTU the nurse will ask you how you have been since your last treatment. It is important that you tell them if you are experiencing side effects, so that they can monitor your progress throughout your treatment.

It may be necessary to delay your treatment for a short period of time if blood tests or side effects show us that you need a longer recovery time, or additional drugs to support your recovery, or the dose of chemotherapy fine-tuned. The nurses will discuss this with you and tell you about any extra blood tests or medications and give you the new treatment appointments before you leave.

The treatment or procedure

The treatment team will confirm with you the length of time you can expect to be in DTU and the process involved. Time is needed for staff to review your blood results, check the prescription and make up the drugs. This is essential to ensure that you receive your treatment safely. We aim to keep you informed, but if you are concerned about any delay then please speak to your Nurse, or the Nurse Coordinator at the nurses’ station.

Following treatment

You may be given additional medications to help control expected side effects. The nurses or pharmacists will explain how and when to take these.

If you feel unwell after you leave DTU please contact the Oxford Triage Team.

  • Oxford Triage Team: 01865 572192

They will assess your problems and concerns over the telephone, and either provide advice or ask you to come into the hospital to be seen by a doctor.

If you are feeling unwell when you arrive at DTU, let the nurse know as soon as possible, so that they can arrange for a doctor to see you. Our doctors do not work in the Unit, so we need to arrange for them to come and see you. If you feel unable to travel into DTU, contact the DTU staff or Oxford Triage Team to seek advice before you leave home.

Common side effects of chemotherapy

The side effects of chemotherapy treatment vary from one person to another. You will notice them gradually developing and improving in the rest weeks after treatment.

Your nurses and doctors will discuss the side effects of the drugs you are having and how you can monitor and cope with these. They will also give you an information leaflet for your drugs to guide you and your family when you go home. We have included some common side effects below - your Nurse will tell you if these will affect you.

Changes in your blood

Your chemotherapy can sometimes affect your bone marrow, which produces different types of blood cells, making it more likely that you can get an infection. This may be a life-threatening complication. If you have a temperature of 37.5 degrees or above, feel shivery or flu-like and generally unwell, you should contact the Oxford Triage Team immediately.

  • Oxford Triage Team: 01865 572192

Diarrhoea

This is a side effect associated with some forms of chemotherapy. If you experience more than four bowel movements a day, or have any diarrhoea at night, you should contact the Oxford Triage Team for advice immediately. It is important that you drink plenty of fluids if you have diarrhoea and seek treatment promptly, as chemotherapy-induced diarrhoea does not stop on its own.

Hair loss and wigs

Not all patients receiving chemotherapy lose all their hair. Sometimes it thins or you may see no difference. Your nurse will explain how your specific treatment can affect your hair.

Before your treatment begins the nurse will explain how to obtain a wig, including recommended shops. There is a form to complete and, unless you are exempt, there is a prescription charge (£64.95) payable at the hospital Cashiers Office.

They will complete the form which can then be taken to a hospital approved supplier. The suppliers often provide a fitting service so that the wig can be trimmed or brushed to the style you like. They will also tell you how best to look after your wig.

Wigs can feel tight and uncomfortable, as your skin will be more sensitive during, and sometimes after, treatment. Towelling turbans are available, or a light cotton or silk scarf, or soft hat, may feel more comfortable. Your hairdresser may be able to help you find a style which will cover any hair loss or patchy area. Further information can be found in the Macmillan leaflet 'Coping with Hair Loss'. You can read this online at the link below or ask your nurse for a copy.

Tiredness and emotions

You may experience a feeling of tiredness, so allow yourself extra time to rest. It can be an emotional time during your treatment. You may feel anxious and uncertain before your appointment, or you may be keen to keep up your normal routines and find that the ongoing tiredness and feelings are holding you back. This is natural and it is important to give yourself time to adjust - the recovery time between treatments differs for every individual.

Support may be available from family and friends. It might help you to keep up some hobbies and social activities you enjoy - gentle exercise can boost your mood. Both you and those around you can find impartial advice and support from Maggie's Centre at the Churchill Hospital. They will have information on local support groups, counselling services and complementary therapies. Your GP can also be a source of support and advice regarding the impact of your experience on your emotions and relationships (including sexual relationships) and may refer you to local counselling services.

Sexual effects

Depending on your treatment, chemotherapy can sometimes cause emotional changes that may affect your sex life. If you are having problems it may help to talk these over with your partner and your medical team. Although it can be embarrassing to talk to health professionals about such intimate things, remember they are used to dealing with these issues and can suggest things that can help.

Once your chemotherapy is over

After the chemotherapy has completed you will be seen by your Oncologist or Haematologist in the Outpatient Clinic. The timing of the follow-up appointment is important to allow the doctor to assess the effectiveness of the chemotherapy and to advise you about any ongoing side effects.

If you have any questions, or need support and advice now that your chemotherapy is finished, please contact the Oxford Triage Team in the first month following treatment. After this time contact your GP or District Nurse or Cancer Nurse Specialist.