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Chemotherapy protocols

Information for patients and carers

Welcome

At Mater Private Hospital Brisbane, we acknowledge that being admitted to hospital can be a very stressful experience. This booklet aims to alleviate some of your concerns, in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients' needs. It explains the general day to day events that may occur during your visit and the things to expect when you are discharged from hospital.

It is, however, only a guideline as each person is an individual and may react differently and require differing treatments.

If you have any questions about your treatment please ask your doctor or nurse.

Our pastoral care team also offers a caring support network to all patients regardless of religion. The dedicated members of this team are available at your request.

Day of admission

On arrival to the hospital staff will escort you to your room. The admitting nurse will orientate you to the room and facilities. If this is your first stay at Mater Private Hospital Brisbane, you will receive a copy of the information booklet detailing the functions of the oncology unit. This contains important information for you, your family and friends. An armband will be applied to your arm, which stays on for the duration of your stay for identification and safety reasons. A detailed medical and surgical history will be gathered so that we can best plan your individualised care whilst you are in hospital

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Daily hospital routine

Test/procedures

It is likely that you will require some type of central line which will be inserted at the direction of your doctor. This is necessary for administering drugs and for taking blood samples. For more information please refer to the side effect information booklet.

Daily blood tests will be taken to check your blood cells, liver, kidney function, bleeding studies and blood group. These tests are usually taken early each morning.

Some chemotherapy treatments result in a steady reduction in your blood cell counts. If the counts are low you may require blood or platelet transfusions.

If you develop a temperature and have been commenced on antibiotic treatment, additional tests may be required (e.g. blood cultures, chest X-ray, urine and faeces cultures) to identify any infections that may be present.

Consults

Your doctor may have seen you before your admission to hospital or they will visit you after you have been admitted. Your doctor will discuss with you which of the above tests and procedures they are organising. Depending on your current level of health and past medical history they may ask for a number of doctors to see you. This may include a vascular surgeon to arrange for the insertion of a central line (if you do not already have one), cardiologist, respiratory or infectious disease physician. They will continue to visit you daily.

The dietitian will visit you initially to conduct a nutrition assessment and provide important information regarding your dietary requirements. You may also be visited by a physiotherapist if necessary.

Any counselling or support needs you or your family may have should be raised with your nurse who will ensure you are visited by one of the following people—advanced practice nurse, supportive care nurse, or nurse unit manager.

Mobility

It is important that you maintain a certain amount of exercise each day during your stay. This may include walking or exercises in bed. There are also exercise bikes available for use if your doctor has approved this. For those people requiring assistance, your nurse will schedule this into your care or your family may wish to help. A physiotherapist may also visit you if required.

Hygiene

Hygiene will play an important role during your stay and this is something you may do yourself. You will be required to shower daily with an antiseptic solution, chlorhexidine. Talcum powder and perfumed soaps are best avoided. Make up is discouraged because it masks rashes and possible signs of infection and your treatment may cause skin sensitivity.

The nurse will also give you mouthwashes to use (especially after meals and before you go to bed). You will also need to buy a soft toothbrush. If you notice your mouth is sore or painful, notify your nurse and increase the frequency of your mouthwashes. A more detailed information sheet on mouth care will be given to you.

To avoid injury to the skin, men should use an electric razor to shave.

Nutrition

If you are on any special diets please let your nurse know. During treatment we encourage you to have a high protein diet to assist your body to cope with the chemotherapy treatment. An information sheet on nutritional support will be given to you. A decreased appetite, nausea, mouth ulcers and taste changes can be a problem during treatment. If this occurs the dietitian can alter your meals and arrange high protein supplements to assist you in meeting your body's needs for protein and energy. You will be given an information sheet on nausea and vomiting as you may experience this sometime during your treatment. It will give you helpful hints on how to manage this. If you develop constipation you may wish to increase the fibre in your diet by eating prunes or drinking prune or pear juice. Whilst in hospital these can be ordered with your breakfast.

Continence

If able, you may walk to the toilet. At times you will be started on a fluid balance chart, which will monitor both what you drink and your urine output. Depending on the chemotherapy drugs you are receiving, your urine may be tested for blood and pH. You will also commence on a bowel chart to monitor the frequency of your stools. Please let your nurse know if there are any changes in your bowel motion, frequency or consistency.

Observations

Your nurse will take a baseline set of observations on admission (blood pressure, temperature, pulse, respirations, and oxygen saturations). If this is your first admission your height and weight will also be recorded and these will be used to order your chemotherapy drugs. Your observations will continue to be taken at least four times a day during your stay. Your weight and oxygen saturations will be monitored at least once a day. If there is an increase in your weight due to excess fluid you may be given an injection to remove this fluid.

Medications/infusions

Some medicines can be harmful to take when you are having chemotherapy (including those bought in a shop or chemist). Please let you doctor know about any medicines you are taking including over the counter drugs, complementary therapies and herbal remedies.

After review by your doctor you will continue to take your regular medications. Your doctor may also commence you on medications which will help to protect your kidneys from the chemotherapy treatment you are about to receive. If you are showing signs of infection or if you have a temperature on admission, you may be started on antibiotics. Depending on your chemotherapy protocol, treatment can take between one to seven days to complete. Your doctor may also order intravenous fluids to be given at the same time you receive your chemotherapy. There are a number of other supportive drugs that your doctor may order throughout your stay which will be explained to you.

Once your chemotherapy commences, you will be started on antiemetics regularly to prevent and control any nausea and vomiting you may have. A side effect of one antiemetic (Zofran) is constipation. We will monitor you every day for signs of this and you may be given an aperient to avoid constipation.

Education/support

We understand this may be a stressful time for you and your family. Anxiety and stress are a normal part of the cancer experience. The emotions you experience and how you deal with them is an important aspect of your care.

The nursing staff are available to support you by providing as much information as you require. You will also be provided with a number of booklets to help you understand the treatment you are about to undertake. If you or your family are concerned, please speak to your nurse.

If you or your carer have any questions you might like to write them down or ask your nurse when you think of them.

It is important to let your relatives and friends know that you will not be able to have flowers in your room.

Chemotherapy treatment

Once your doctor has reviewed all the tests they will order the chemotherapy drugs. The chemotherapy may be given over one day or for several days. Chemotherapy drugs can be given in a variety of combinations and this will be decided by your doctor to best meet your individual needs. At times there are supportive drugs given in combination with your chemotherapy and these will be discussed with you.

You will be given handouts on the drugs you are to receive covering: a description of the drug, how it is given and its side effects.

The day that you start chemotherapy is called 'day one'. After the chemotherapy is given there is a rest period of anywhere from seven to 21 days while we wait for your body to recover from the effects of the chemotherapy.

Chemotherapy cannot distinguish between normal and cancer cells. Those cells dividing at a rapid rate within the body are more susceptible to the effects of chemotherapy. Normal cells most likely to be affected are the bone marrow (low blood counts), hair follicles, cells of the mouth, gastrointestinal tract, and reproductive system. The symptoms or side effects of the chemotherapy are directly related to the cells that are affected by the chemotherapy.

It is not advisable to become pregnant or father a child while on chemotherapy as the developing foetus can be harmed. It is important to use effective contraception while on chemotherapy and for several months afterwards. Certain chemotherapy drugs may also affect fertility (ability to become pregnant or to father a child). It is important to discuss these issues with your doctor before starting treatment.

The name of your protocol is _________________________________________
Estimated number of cycles is ________________every _____________ week/s
Your supportive drugs are:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

After chemotherapy

It is important to continue your daily shower and maintain your mouth washes. You should continue to exercise as much as possible as this will help prevent some infections you may develop. There are exercises listed in the side effect booklet which you can follow. Your weight will continue to be monitored at least twice a week and at times daily and reported to the doctor if there is an increase. Sometimes your body can retain certain fluids and you may be given a drug called Lasix to help remove any excess fluid.

The best way for you to receive your nutritional support is to continue eating a high protein, high carbohydrate diet. There may be days when you do not feel like eating. This is normal. It is important however to maintain your fluid intake and there are a variety of drinks that you can have which will maintain your nutritional level. There may also be times when your doctor may say to limit your intake due to side effects you are experiencing. If this occurs you may start to receive total parenteral nutrition through your central line.

After your chemotherapy has been completed, your blood cell count may drop and for some this may drop to very low levels. The aim of care at this time is to prevent infections developing and maintaining your red cells and platelet count.

During this period some common side effects of the chemotherapy include:

  • low blood counts
  • diarrhoea
  • mucositis (inflammation of the lining of the mouth and gastrointestinal tract)
  • infection and prevention of infection
  • alopecia (hair loss)
  • fatigue.

You will be given information sheets on these common side effects to refer to throughout your treatment.

Discharge advice following chemotherapy

What to expect:

  • You can expect to be discharged either the day following the completion of your chemotherapy or when your blood counts have recovered.
  • Your doctor and nurse will arrange follow up appointments for blood tests as required to monitor your progress.
  • If you go home with your central line your nurse will teach you how to care for it.
  • If you tolerate treatment and have few side effects you may have your remaining courses as an outpatient and visit the clinic daily for your treatment.
  • For those who have received steroids as part of their treatment it can be common to feel tired after stopping treatment. This should improve after a few days.
  • Your appetite may be poor, however this improves once you return home.

What to do at home

  • Continue to take your medications at home as ordered by your doctor.
  • Maintain an adequate fluid intake.
  • Continue some form of exercise/activity.
  • Monitor your central line looking for any swelling or redness.
  • Take your temperature at least once a day or as directed by your doctor and nurse.

What to avoid:

  • People with colds, "flu" like symptoms or viral infections such as chickenpox or measles.
  • Gardening and handling pets.
  • Injury to the skin that may lead to bleeding and infection.
  • Large crowds unless your doctor advises otherwise.
  • Home renovations e.g. lifting floor coverings, sanding, knocking down walls.

Immediately report the following side effects to your doctor:

  • Any temperature greater than 38 degrees Celsius.
  • Any swelling, tenderness, redness or drainage of your central line.
  • Any signs of swelling or pain in your calf muscle which may suggest a clot.
  • Any signs of bleeding or bruising—black/tarry stools or blood in stools.
  • Any uncontrolled vomiting or diarrhoea.
  • If you are unable to tolerate any food or fluids for a 24 hour period.

Useful contacts

Mater Private Hospital Brisbane

Vulture Street, South Brisbane, Qld 4101
Phone: 07 3163 1111

Mater Private Hospital Brisbane Oncology Unit

Nurse Unit Manager—Myles Sweedman
Phone: 07 3163 2893

Advanced Practice Nurse—Diana Moore
Phone: 07 3163 2243

Oncology educator—Jane Roach
Phone: 07 3163 1552

Ward Clerk—Jan Alsweiler
Phone: 07 3163 1556

Palliative Care Clinical Nurse Consultants

Clinical Nurses—Liz Macknight or Danielle Roach
Phone: 0434 589 802

Mater Private Centre for Haematology and Oncology

Phone: 07 3737 4500
Clinical Nurse Manager
Phone (after hours): 07 3834 6922

Leukaemia Foundation Units

Clem Jones Sunland Village, 170 Middle Street, Coopers Plains, Qld 4108.
Phone: 07 3840 3840

Pastoral Care

Mater Private Hospital Brisbane
301 Vulture Street, South Brisbane, Qld 4101
Phone: 07 3163 1053

Please request Pastoral Care to be paged on your behalf if there is no answer on the above number.

Useful websites

Below is a list of useful national and international websites that you may wish to access. This list is not comprehensive and each site may have links to other websites not listed here.

Australian sites

Cancer Council Queensland

Cancer Institute NSW

Leukaemia Foundation

CanSpeak QLD

Canteen Australia

National Breast and Ovarian Cancer Centre

International sites

American Cancer Society

National Cancer Institute—US

British Association of Cancer Patients(Cancer Backup, UK)

International Myeloma Foundation

Leukemia and Lymphoma Society

National Institutes of Health

LIVESTRONG TM Young Adult Alliance

Mater Private Hospital Brisbane
301 Vulture Street, South Brisbane Q 4101
Telephone: 07 3163 2590
© 2012 Mater Misericordiae Ltd. ACN 096 708 922.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-450007
Last modified 09/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 10/7/2013
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