Additional GP information

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What information has your patient has been given in addition to the verbal consultation with the doctor and specialist nurse your patients has been given an information pack containing:

• general information sheet on chemotherapy
• (cancernet.co.uk/chemotherapy.htm)  
• specific sheet for their specific regimens (see chemotherapy.htm)
• lifestyle & symptom advice sheet (chemo-lifestyle.htm) 
• contact numbers and advice (chemo-numbers.htm)
• directory of services of our information suit
• our copy of our general information video/DVD
• a card with information website address (cancernet.co.uk)

Admission advice Dr Thomas, Dr Bulusu & Dr Smith do not have beds at Bedford Hospital as patients are admitted under the on-call medical or surgical team. Patients receiving systemic chemotherapy who develop problems should be admitted to the on call team in the AAU (Acute Assessment Unit) at Bedford Hospital (01234 795987).  
Patients with a temperature should not be sent to A&E without a discussion with the on call Registrar. Following admission patients may then be transferred to the care of the consultant who referred your patient to the primrose Unit initially. The consultant will then be notified and will offer further advice. 
If a patient is admitted to another hospital further advice can be obtained by ringing D9 ward at Addenbrooke's Hospital 01223 216373) or the registrar on call at Addenbrooke’s for the antibiotic policy via switch board 01223 245151.
Patients receiving palliative chemotherapy who also have tumour related problems are best admitted to Bedford or directly to St John’s, Moggerhanger. (01767 640622). 

Nausea & Vomiting  Nausea remains a relatively common side effect of chemotherapy but with the advent of HT3 antagonists vomiting is unusual. It is important to treat vomiting actively as prolonged vomited leads to rapid dehydration, renal impairment and sometimes sero-concentration of the chemotherapy drug leading to more profound side effects. Patients would have been given range of anti-emetics, but if these are not working further measures are required: 
Exclude other medical causes of nausea including other drugs such as pain killers - particularly morphine based drugs or codeine. Anti-inflammatory drugs, hormone therapies, or some anti-biotics such as erythromycin.
If the patient has been given an additional suppository – ask them to use it. If the suppository of ondansetron 16mg or other measures such as im injection of stemetil  fails or there is a suspicion of dehydration the patient is best admitted.

Extravasation A small number of chemotherapy drugs can cause irritation and tissue damage. If they leak out of the vein whilst injected. This is called extravasation. All Nurses who administer chemotherapy have completed an intensive training programme and are fully aware of which drugs are more likely to cause these problems and what to do if extravasation occurs. Rarely problems can start after patients have left the unit. If patients complain of pain, redness, swelling, stinging or burning at the injection site unit contact the clinic via emergency numbers you have been given. In the mean time keep the arm raised and place a cool (not ice) pack on the area.

Diarrhoea Some chemotherapy agent can cause diarrhoea, which if prolonged and severe can cause serious consequences for patients such as dehydration which can alter excretion and increase the risk of neutropenia and infection. The most likely candidates are capecitabine, Uftoral and Irinotecan (campto). Patients are advised to drink plenty of fluids and take loperamide or codeine as required. If this does not control the symptoms,  is associated colicky pains, signs of dehydration or diarrhoea at night the cancer unit or centre should be contacted. If in doubt and otherwise the patient is well (for example in the evening) stop the oral chemotherapy and contact the Unit/centre the next day. If however the patient deteriates they must be admitted for intravenous fluids immediately. 

Mucositis Chemotherapy affects rapidly dividing normal cells such as those that make up the lining of the mouth and gut. This may result in inflammation and ulceration of the mouth lining causing pain and discomfort (particularly oral capecitabine).  Radiotherapy in or around the area of your mouth can make it dry and sore. In these cases or if your white cell count is low after treatment, you will be susceptible to oral infections such as thrush (candida) or cold sores (herpes simplex). Careful attention to mouth care will help reduce the risks of infection and the following instructions are designed to help you keep your mouth clean and comfortable. Oral mucositis  often can be painful, and this in turn can make it difficult to eat and drink, which if prolonged and severe can cause serious cons