Having your chemotherapy at East Cheshire NHS Trust

Having your chemotherapy at East Cheshire NHS Trust Macmillan Cancer Resource Centre Phone no: 01625 663184 www.eastcheshire.nhs.uk Leaflet Ref: 10121 Review: 11/2017 Page 1

Introduction We hope that you and your family will find this booklet a useful guide about having your chemotherapy at Macclesfield District General Hospital, part of the East Cheshire NHS Trust. It will possibly not answer all your questions about having your chemotherapy, and is not intended as a substitute for discussion with the doctors and nursing staff. If you read this booklet and still have some questions or concerns, please do not hesitate to ask. The nurse will give you more detailed information about individual chemotherapy treatments. How is the treatment organised? Your chemotherapy is prescribed and managed by the consultant oncologist (cancer specialist) from the Christie Hospital. Dr Catherine McBain visits the hospital every Monday and Dr Lisa Barraclough visits every Wednesday. During these clinics they see a large number of patients, not all of whom are currently having chemotherapy. Once you have seen the doctor and agreed that you would benefit from chemotherapy treatment, as an outpatient at Macclesfield Hospital, you will be given written information about the drugs that are going to be used. You will also be given an appointment to see one of the chemotherapy nurses. This appointment is to discuss your chemotherapy treatment, and to take a blood sample prior to the start of the treatment. This will give you the opportunity to ask questions about your chemotherapy treatment, and you will be asked to sign a consent form. You may want to bring your partner or friend to this appointment. Blood tests The blood test that you will have is to assess your full blood count, (the number of red cells, white cells and platelets) and your renal (kidney) function, prior to your chemotherapy. Once treatment has started you will need to have blood tests on a regular basis. Your chemotherapy nurse will advise you on this, as it varies for the chemotherapy regime that each individual is having. Sometimes, treatment has to be delayed by one or two weeks if your blood count has not returned to normal following the last cycle of treatment. If this happens, the delay does not reduce the efficacy of your treatment. The chemotherapy nurses will advise you on when and where to have your blood tests. Leaflet Ref: 10121 Review: 11/2017 Page 2

Red blood cells These give the blood its colour and carry oxygen from the lungs to all the parts of the body. A reduction in the number of these cells is called anaemia. A mild form of anaemia may result from chemotherapy, but it usually improves without any treatment. Very occasionally an injection to promote better growth of red cells or a blood transfusion is necessary. White blood cells These help the body fight infections. When the number of white cells are low the body s resistance to infection is reduced. The white cell count usually drops between one and two weeks after chemotherapy and recovers by the end of the third week. Neutropenia is the lack of neutrophils (a particular white blood cell) in the body. It is the commonest important side effect of chemotherapy. The risk of infection increases as the neutrophil count gets lower and in this situation even what appear to be minor infections can become serious in a matter of hours. You will be given advice and contact numbers to help you cope with this type of problem if it occurs. Sometimes the doctor will prescribe a short course of growth injections to encourage the body to produce more neutrophils. Platelets These are needed to help your blood clot. If the number of platelets becomes very low, patients may notice that their gums bleed when they are brushing their teeth. Nosebleeds can also happen and their skin can bruise more easily. The platelet count usually improves without treatment. If it gets very low a platelet infusion is possible. In practice platelet problems are very rare. Other tests We may need to check the function of other organs before starting chemotherapy. The choice, dosage or schedule of your treatments may need to be modified when these results are available. Kidneys Most chemotherapy is removed from your body by your kidneys, therefore it is important to make sure that your kidney function is satisfactory before starting treatment. This may be monitored by taking a blood test or we may ask you to collect your urine for 24 hours in a special bottle. It is very important that you collect all your urine during this time. Sometimes the doctor will ask for a GFR (glomerular filtration rate). This measures the rate that drugs are filtered through the kidneys. Leaflet Ref: 10121 Review: 11/2017 Page 3

Heart Certain chemotherapy drugs can affect the heart. The doctor will ask you if you have any heart problems such as high blood pressure or angina. If you have a history of such problems the doctor may ask for additional tests such as a tracing of your heart (ECG - electrocardiogram) or a heart scan (echocardiogram). Liver This can be monitored by a blood test. Are there any side effects? Chemotherapy affects some normal cells and when it does, side effects can occur. The side affects you may have will depend on the particular drug or combination of drugs you receive. Your doctor or chemotherapy nurse will discuss these with you, and you will receive a written information leaflet on the particular chemotherapy treatment that is appropriate for you. Pre-ordering of chemotherapy This means that your chemotherapy is prepared for you in advance so you should not have to wait. Chemotherapy is prepared in the pharmacy department by a team of technicians and a specialist pharmacist. What happens on the day of treatment? Book in at the reception desk in the Cancer Resource Centre and take a seat. A volunteer makes hot and cold drinks on request. A nurse or receptionist will direct you to the treatment area. You will see the doctor on a regular basis to ensure that you are coping with the treatment, and you will have an opportunity to ask questions and discuss issues that may be concerning you. The appointments vary depending on the chemotherapy that you are receiving. This may not be on the day of treatment. If you are not due to see the doctor, the chemotherapy nurse will discuss with you any concerns you may have. If you wish to see the consultant about any problems related to your treatment, please ask the nurse and it can be arranged. Leaflet Ref: 10121 Review: 11/2017 Page 4

A small needle (cannula) is put in the back of your hand or forearm and a drip attached. The chemotherapy is then administered through the drip. This is given by a chemotherapy nurse, and should be no more painful than any other injection or blood test. If you do feel pain or are anxious about having injections, please tell the chemotherapy nurse. An infusion pump can give some chemotherapy regimes. Usually it will take 30-45 minutes to have your treatment. Obviously this depends on what chemotherapy treatment you are having, and sometimes this may be longer. Some people will choose to have scalp cooling. This will make the length of stay longer, depending on which drugs you are having. Once you are ready to go home, and the chemotherapy nurse is confident that you are fit to go home, you will be advised to go to the reception to make another appointment. You will be given tablets you need to take at home. The chemotherapy nurse will give you a blood form to take home. You will need to take this with you when having your next blood test. You will be advised when to have your blood tests by the nurse. You will be given a chemotherapy record booklet at your first appointment. It has details of your chemotherapy regime, your antisickness drugs and bloods results. It also has space for you to record any side affects you may experience. Please carry this booklet with you and show it to any health professionals who you need to see during the time you are having chemotherapy. You will need to bring this booklet with you on every visit so the chemotherapy nurse can update it. What happens in between treatments? If you have worries, anxieties or symptoms which cause you concern, please phone for advice. The telephone number is 01625 663203. You will be able to speak to a chemotherapy nurse, or if she is unavailable, you can leave a message and she will return your call. If you have a query and it is after 5pm, on a Bank Holiday or at the weekend you can phone the chemotherapy hotline at the Christie hospital. The telephone number is 0161 446 3658 and is open 24 hours a day. Leaflet Ref: 10121 Review: 11/2017 Page 5

Please do not wait for your next appointment, what may seem trivial to you could develop into something very serious. If we feel that you have a problem that can be managed by your GP, after discussing it with the oncologist, we will contact your GP and agree a course of action. If you need to be admitted to hospital for any reason between treatments, please remind the health professionals caring for you that you are receiving chemotherapy and show them your record card. They may need to contact the oncology team to discuss your care. Chemotherapy and everyday life Holidays Before booking a holiday please discuss this with your doctor, as it may be better to wait until your treatment is over. If you have a holiday already planned, ask the doctor for their advice about going or cancelling it. You may be still able to go on holiday and have a break from the treatment, but this will depend on where you are planning to go and the stage in your treatment. Macmillan Cancer Support has information about travel insurance for people being treated for cancer and the Cancer Resource Centre can provide an up-to-date list of helpful companies. Activities Some people having chemotherapy are able to lead a normal life, carrying on their social life and continuing to work. Some people carry on with their job in between treatments and just have a day or two off at the time of treatment. Others feel too tired to continue working and have time off. Be guided by how you feel, but be sure to rest when you become tired. It is best to be particularly careful about taking on any extra commitments during the first two courses until you see how you are reacting to the treatment. Other tablets and medicines Please ensure the doctor knows about any medication that you are currently taking, including ones that you buy from the chemist. Whilst you are being treated as an outpatient, you will have to pay for other prescriptions unless you are exempt. You may find it cheaper to buy a season ticket. Please ask us for advice about this. There is a NHS leaflet available about this in the Cancer Resource Centre. Leaflet Ref: 10121 Review: 11/2017 Page 6

Fertility and contraception Women It is not advisable to become pregnant whilst having chemotherapy as it may harm the developing fetus. It is important to use effective contraception whilst having chemotherapy and for at least a few months afterwards. It is safer to use a condom or other form of barrier contraception. Due to the effect of chemotherapy on the ovaries, menstrual periods often become irregular or stop during treatment. In younger women this may be temporary but if you are closer to your menopause it may be permanent. This may result in menopausal symptoms such as hot flushes and sweats and vaginal dryness. If you are worried about this please ask your doctor or chemotherapy nurse for more information. Men Some types of chemotherapy cause infertility. If this is likely, your doctor will discuss the possibility of sperm banking before you start the treatment. You may remain fertile during the early stages of treatment, but it is important that you do not father children whilst receiving chemotherapy, because of the risk of damage to the developing fetus. If you have any worries or questions about this, please ask the doctor or chemotherapy nurse. Useful contact numbers Joy Bailey, Chemotherapy nurse specialist 01625 663203 Carla Morris, Chemotherapy nurse Chemotherapy suite 01625 663198 Macmillan Cancer Resource Centre, Macclesfield Hospital Oncology secretary to Dr McBain 01625 663148 and Dr Barraclough, Macclesfield Hospital, Carol Burdell Macmillan Information & Support Manager, Janet Dale Macmillan Cancer Resource Centre 01625 663128 Consultant Oncologist, Dr Catherine McBain 0161 446 3330 Consultant Oncologist, Dr Lisa Barraclough 0161 446 3406 Macmillan Pharmacist, Julie Whitehead 01625 661183 Oncology Clinic Receptionist Team Appointments 01625 661345 Reception Desk 01625 663184 Leaflet Ref: 10121 Review: 11/2017 Page 7

Chemotherapy hotline: The Christie Hospital 0161 446 3658 Macmillan Cancer Line 0808 808 2020 Cancer BACKUP 0808 800 1234 Benefit enquiry line 0808 801 0304 Useful websites www.breastcancercare.org.uk www.christie.man.ac.uk www.coloncancer.org.uk www.lungcanceronline.org www.lymphoma.org.uk www.macmillan.org.uk www.nhsdirect.nhs.uk www.ovacome.org.uk www.prostate-cancer.org.uk www.roycastle.org References: http://cks.clarity.co.uk/patient_information_leaflet/ chemotherapy Leaflet Ref: 10121 Review: 11/2017 Page 8

For further information on the references and sources used for this leaflet, please contact 01625 661184. Comments, compliments or complaints We welcome any suggestions you have about the quality of our care and our services. Contact us: Freephone: 0800 1613997 Phone: 01625 661449 Textphone: 01625 663723 Customer Care, Reception, Macclesfield District General Hospital, Victoria Road, SK10 3BL For large print, audio, Braille version or translation, contact Communications and Engagement on 0800 195 4194. East Cheshire NHS Trust operates a smoke-free policy (including e-cigarettes) For advice on stopping smoking please contact our Stop Smoking Service on 0800 085 8818. East Cheshire NHS Trust does not tolerate any form of discrimination, harassment, bullying or abuse and is committed to ensuring that patients, staff and the public are treated fairly, with dignity and respect. Leaflet Ref: 10121 Review: 11/2017 Page 9