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Date issued: February 2024 

For review: February 2026

Ref: C-133/Oncology/SW/Chemotherapy v14

PDF:  Chemotherapy And Systemic Anti-Cancer Therapy 2024 v14.pdf[pdf] 374KB

Information for patients, their families and carers

This is an information booklet to help you and your family understand chemotherapy and other anti-cancer treatments, its effects on your body and how you can help yourself. It will supplement the information given to you by your doctors, nurse specialist, ward nurses, and other staff you may meet.

You will also be given an information sheet from Macmillan giving details of your specific regime and drugs.

Contact numbers:

Oncology Patients

Only for unwell oncology patients or with a temperature please call: 01752 202082 and then ask for the oncology nurse on Bleep 0023 (available 24 hours a day)

Fal Ward: 01752 430290 or 430291

(For general enquiries Monday to Friday 9am to 5pm)

Oncology Outpatients: 01752 430428

(For general enquiries and oral chemotherapy blood results, Monday to Friday 9am to 5pm)

Brent Ward: 01752 430043

(For general enquiries overnight and weekends)

Haematology Patients

If you are feeling unwell or have a temperature, please call:

01752 202082 and ask for the OPERATOR.  Ask the operator for the HAEMATOLOGY TRIAGE NURSE on Bleep 0228. This is available 24 hours a day.

Your call will then be answered by one of the haematology nurses.  Please do not use this number for general enquiries.  It is solely for the use of patients who are unwell and need advice.

Birch Day Case: 01752 432674 (Birch Reception) or 01752

432678 (Nurses Station) (For general enquiries Monday to Friday 8.30am to 6.30pm)

Bracken Ward: 01752 432494

(For general enquiries)

Emergencies:

Information on what to do in the event of an emergency.

What is chemotherapy?

The word ‘chemotherapy’ means treatment with drugs. The word is used mostly to mean the treatment of cancer. Sometimes the drugs used to treat cancer are called cytotoxic drugs. The word cytotoxic means poisonous or toxic to the cells of the body.

Your chemotherapy treatment will depend on the type of cancer you have. Different drugs work best on different cancers. Sometimes only one drug is required. Often more than one drug is used to make the treatment more effective. A single treatment may be given, or it may be repeated with a rest between each treatment.

Sometimes chemotherapy is used with surgery and / or radiotherapy to treat certain types of cancer. Chemotherapy given soon after surgery is often referred to as adjuvant treatment. Similarly, if chemotherapy is given before surgery, it is called neo-adjuvant treatment.

What is Systemic Anti-Cancer Therapy (SACT)

Systemic Anti-Cancer Therapy or SACT is a term that covers chemotherapy but also includes the next generation of medication to treat cancer. You might hear these treatments being called ‘targeted therapies, biological therapies, monoclonal anti-bodies or immunotherapies’.

These drugs work differently from chemotherapy. Some of these treatments will target specific markers on the cell surface to stop them growing or help the immune system to recognise and attack the cancer cells. Other treatments can block growth factors which stimulate some cancers to grow.

These treatments can be given as tablets, an injection or as intravenous medication and patients can sometimes have a specified number of treatments or remain on them indefinitely.

As these SACT treatments can be so different and complex this information booklet does not go into all of them in detail. It is therefore important that you receive the individual drug information from your Clinical Nurse Specialist (CNS) or the nurse treating you and to follow the advice carefully.

Immunotherapy: Checkpoint Inhibitors

Immunotherapy is a specific form of systemic anti-cancer therapy which works by releasing the brakes on your immune system so that it can destroy the cancer cells. You will be told if you are receiving immunotherapy as there are currently only a few drugs that work in this way. 

There is now an information booklet for patients and their families specifically about immunotherapy treatment. Please ensure you obtain this from your specialist nurse or doctor if this applies to you.

There is also a short film available on the ‘MySunrise App’ regarding immunotherapy and the potential side effects it can cause. Once you have the app downloaded the film can be found under:

‘Treatments’ > Systemic Anti-Cancer Therapy’ > ‘Immunotherapies’.

There is more information regarding ‘MySunrise’ App on page 33.

How does chemotherapy work?

The drug can be given as tablets or capsules, or injected into a vein, so that it can enter your bloodstream. Tablets or capsules dissolve in your gut and the drug passes through the gut wall into your bloodstream. The drug is carried around your body in the bloodstream to reach the cancer cells. The drug gets into the cancer cells and may damage their genetic material (DNA). This may prevent the cancer cells from growing and dividing in an uncontrolled way.

However, cytotoxic drugs damage healthy cells as well, but the healthy cells are much more able to recover than the cancer cells. When healthy cells are affected, you may get temporary side effects, such as feeling sick, losing your hair, or getting a sore mouth.

Usually, your chemotherapy is followed by a rest period e.g. chemotherapy on one day and then 20 days rest period (this is then referred to as a cycle of chemotherapy). The rest period is most often longer than the chemo period. This rest or break is important as it gives your body’s healthy cells time to recover from the unwanted effects of the treatment.

This plan or regime of chemotherapy varies from cancer to cancer. Cycles of chemotherapy can be as short as a week or as long as six weeks. Your doctor and chemotherapy nurse will explain the details to you.

How is chemotherapy or systemic anti-cancer therapy given (SACT)?

The way chemotherapy/SACT is given will depend on the drug and the course of treatment prescribed. Chemotherapy/SACT can be given in the following ways:

As an intravenous injection or drip

This is the most common way of giving chemotherapy/SACT. These intravenous injections (IVs) may be given over a few minutes, or as drips, intravenous infusions over an hour or several hours. The type of IV will depend on your particular cancer and which drugs are most effective.

As tablets or capsules

You may be given tablets and/or capsules as part, or all of your treatment. The doctor, nurse and / or pharmacist will explain the medicines to you and suggest when to take them. If you have any questions about your medicines please ask one of the staff.

If I’m given chemotherapy or SACT in tablet form should I take any special precautions?

You will need to take some simple precautions to limit exposure for anyone handling your chemotherapy tablets. Pregnant women should avoid handling them altogether.

• If you are taking tablets or capsules, do not touch them directly if at all possible but tip them gently from the bottle onto a spoon or pot.

• Swallow tablets and capsules with plenty of water. DO NOT CHEW OR CRUSH unless specifically told to do so.

• Be careful how you store and dispose of any containers.

• Store them well out of the reach of children in a cool, dry cupboard unless told otherwise by your pharmacist or nurse.

• Any unused drug should be returned to the hospital or your local chemist for safe disposal

• Always wash your hands after handling any chemotherapy

As a continuous infusion

Sometimes it is useful to infuse a chemotherapy/SACT drug continuously for a few days. You will have a Permanent Central Line or PICC inserted into one of your veins and then carry/wear a small portable pump which will infuse the treatment for the designated amount of time.

Injected beneath the skin

A few drugs may be given to you as an injection just beneath your skin (a subcutaneous injection) or into a muscle (an intramuscular injection).

Injections and drips

Will it hurt?

One of our biggest concerns is not to hurt you. We appreciate that you are already upset by having cancer and that you may be feeling very vulnerable.

We have specialist Chemotherapy/SACT Nursing Services working on Fal Ward and Birch Day Case Unit, and experienced highly trained cancer nurses on Brent and Bracken Wards. Your Cancer Nurses have great experience and expertise in putting in patient’s needles (called cannulating). We always use the smallest possible size ‘needle’ (cannula) often a child size. Most of these cannulae are put in the veins on the back of your hand or the lower part of your forearm.

Some patients, due to the nature of their treatment, will require Hickman, PICC lines or TIVADs, so that they can have continuous or multiple chemotherapies.

Hickman, PICC lines and TIVADs

A Hickman line is a long thin tube put into the large vein above the heart. This tube then leads out to the surface of your body underneath the skin of your chest. The tube is left in place for several weeks or months while you need treatment. It needs weekly flushing to prevent it becoming blocked and the dressing changed.

PICC stands for Peripherally Inserted Central Catheter. A PICC line is a long thin soft tube inserted into a large vein in the upper arm. This tube then leads into the bigger veins in your chest just above your heart. The PICC is kept in place by an adhesive pad and a clear plastic dressing.

Like other central lines the PICC can be left in place for several weeks or months. It will need weekly flushing and dressings, which is usually done by the nurses on Fal or Birch Day Case.  Some District Nurses or Practice Nurses at your local GP surgery have been trained in the care of central lines and may be able to do this line care for you.

If your Hickman or PICC line is not being used frequently, it will still require regular flushing. Your oncology nurses will advise you about this.

TIVAD stands for Totally Implantable Venous Access Device. A TIVAD is a long soft tube that is inserted into one of the large veins in your body. One end of the tube sits in a vein, usually just above the heart and the other end is attached to an injection port that sits underneath your skin in your upper arm or the chest.  TIVADs are also called Ports or Portacaths. These are usually recommended for patients who need certain types of medicines that irritate or damage small veins.  They are also recommended for patients who need intravenous therapy over a long period of time as an alternative to long-term venous devices that are visible and require dressings and frequent care.  This venous access device is not visible on the skin and might be preferable to some patients as it can mean they can still swim or take baths. It also only needs to be flushed every 28 days instead of every week.

Cannulation: how can I help myself?

You may have noticed that when you are hot (in summer or after a hot bath) the veins in your hands are very big and prominent. Also, when you are cold, your hands and nails look pale and your veins have ‘disappeared’. This is your body’s normal way of maintaining its inner temperature.  You can use this natural reaction to your advantage. When your veins are prominent they will be easier to cannulate.

Therefore, before your chemotherapy/SACT treatment, try to keep yourself warm. You may not feel cold but an extra layer of clothing can help your hand veins dilate and be visible. Also in the cooler months please wear gloves, even indoors in the clinic. It will also help to drink plenty of fluids so that you are well hydrated. If despite these measures your veins are still small we may warm your hands using a bowl of hot water or a hot pack.

Drips and breast patients

Breast cancer patients who have had surgery are often told by their surgical team that we cannot use the veins on their surgery side. Please discuss this with your chemotherapy nurse.

Will I have to stay in hospital?

If your chemotherapy is given to you in tablet form or as an injection or short infusion, you will be treated as an outpatient.

This may be on Fal Ward (oncology) on Level 4 or Birch Day Case (haematology) on Level 8.

If your chemotherapy/SACT infusion is over a longer period or has significant side effects, you will need to be admitted to our wards for one or more nights. Our two wards are Brent Ward, for oncology patients or Bracken Ward for haematology patients.

Will I have side effects?

Some people do not have any side effects after their chemotherapy/SACT. If you do have side effects, they are usually only temporary, and will go when the treatment has stopped.

When you visit the hospital again the doctor and nurse will ask you if you have had any side effects. It is often busy in hospital and clinics and you may not want to bother the doctor with your problems, but it is important that you tell the doctor and nurse about your side effects. You may find it useful to write down when you have any side effects, there are blank pages in the back of this booklet.

What side effects may I have?

Reduced blood cell numbers

Chemotherapy often affects the bone marrow. This is where your body produces your blood cells; red cells, white cells and platelets. The white cells in your body are important as they help you fight infection, they are also short lived, and so they will be quickly reduced by chemotherapy.

About a week after your chemotherapy the number of white cells circulating in your blood stream will be reduced and this will persist for several days. This means that your body is much less resistant to infections, so a minor infection can quickly become very serious and if left untreated can be life-threatening.

Usually, the number of white cells will return to normal within 3 weeks of the chemotherapy treatment.

The other cells in the blood may gradually decline in number with repeated treatments and if you become anaemic (low haemoglobin or red cells) then you may be offered a blood transfusion.

Essential Information

You must contact the hospital immediately if you have any of the following symptoms. The phone numbers are in the back of this book.

• A temperature of 37.5˚C or higher at any time

OR

• A temperature less than 36˚C and feeling unwell

Any of the following symptoms with or without a high temperature;

• Shivering or sweating episodes

• Feeling generally unwell or experiencing flu-like symptoms

• Chesty cough

• Sore Throat

• If you have a PICC or central line and have any redness or discharge around the site, or if you experience any episodes of shivering when the line is flushed.

How can I help myself avoid infections?

Most chemotherapy drugs reduce the body’s resistance to infection. Most infections are caused by your own body flora, not by transmission from other people. Whilst it may be worthwhile trying to avoid large crowds and close contact with people who have coughs and colds, it is also important to practice good personal hygiene.

We advise you to:

• Clean your hands regularly.

• Ensure you maintain good personal hygiene and brush your teeth regularly with a soft bristle toothbrush. Take a bath or shower every day.

• Clean cuts, scrapes and grazes straight away with warm water, soap and an antiseptic

• Stay away from people with a known infection such as flu,chickenpox or diarrhoea and vomiting.

• Avoid any contact with animal waste and wash your hands after handling pets.

• If you are a haematology patient you may be advised to avoid eating ‘high risk’ foods such as raw or undercooked eggs, unpasteurised dairy products, pâté and shellfish.  Please ask your Clinical Nurse Specialist for some dietary guidelines.

Flu vaccinations

All patients who are receiving chemotherapy are advised to have the seasonal influenza and pneumococcal polysaccharide (PPV) vaccines. Vaccines should either be given before commencing chemotherapy or a couple of days prior to a cycle of treatment. Vaccines should be avoided on the day of treatment itself.

If you are a haematology patient your haematologist may recommend that your immediate family members also receive the seasonal influenza vaccine.

Nausea and vomiting

Our aim is to control nausea and to prevent vomiting as far as possible following your treatment. With many drugs you will be given anti-sickness injections. You will also be given anti-sickness tablets to take home. You will be advised on how and when to take these by the nurse treating you. There are different types of anti-sickness drugs so if one does not work for you then please tell your doctor or nurse who will administer a different drug.

There are also steps you can take yourself to minimise symptoms:

• Eat less, but more often, feelings of hunger can be mistaken for feelings of sickness

• Avoid eating fatty or fried foods

• Avoid food with a strong smell, or the smell of food cooking

• Drink plenty of liquid, slowly, taking small sips

• Don’t lie down flat just before or after eating

• You may find ‘Sea bands’, the wrist bands useful, they are available from chemists

• Ginger tablets or capsules, or ginger biscuits can also be helpful.

If you are still feeling or being sick despite trying this advice and taking anti-sickness tablets, contact your GP or the hospital (see numbers at the front of this book).

Loss of appetite

You may find that you “go off” some foods just after your chemotherapy. This may also happen if you feel sick. You may notice an odd taste in your mouth, or that food tastes strange.

This is because the treatment has temporarily damaged your taste buds. If you have a strange taste in your mouth, you may find sucking a strongly flavoured sweet or mint can disguise this. Fresh or tinned pineapple can also help with this symptom.

If your appetite is poor and you are losing weight, please ask your doctor or nurse to arrange for you to see the hospital dietitian.

Sore mouth

You may find that your treatment gives you a sore mouth. It helps if you try and keep your mouth moist and clean. Clean your mouth and gently brush your teeth with a soft toothbrush each morning, evening and after each meal.

If you have dentures, take them out and clean them each morning, evening and after each meal.

If you notice small white ulcers around your lips, or in your mouth or throat, you may have ‘thrush’. This is a common infection of the mouth when people are on treatment or ‘run down’, please contact your G.P. who can examine your mouth and prescribe some medicine or mouth wash.

You may be given mouth wash solution to prevent potential mouth ulcers. Please take this medicine as directed and use it regularly. It is recommended that you dilute these solutions as they can be too harsh used neat. Diluting the mouthwash half and half with water will give you more solution to rinse your mouth.

Diarrhoea

Some of these drugs may cause diarrhoea, which usually settles within a couple of days. If you have diarrhoea, try to drink plenty of water or other drinks to replace the lost fluid. If you have been prescribed anti-diarrhoea tablets, take these as per the prescription. Also, eat less fibre, fruit, vegetables and cereals. You may find that boiled whole grain rice is good for controlling diarrhoea.

If symptoms persist for more than 24 hours, contact your GP or the Hospital (numbers at the front of this book).

If you are receiving an immunotherapy (nivolomab, ipilumumab, pembrolizumab and atezolizumab (this list is not exhaustive) you need to get in touch with the hospital or your Clinical Nurse Specialist (CNS) as the cause of diarrhoea on these treatments is different and can be very serious.

Constipation

Some treatments and anti-sickness drugs may cause constipation. To prevent this, try eating more fibre, fresh fruit and vegetables and drink at least 2 litres of water or similar liquids per day. If this is not adequate and you become constipated, your local pharmacist will advise you on a suitable treatment. If you require further advice, contact your GP or the Hospital (numbers at the front of this book).

Painful, burning, red skin following intravenous injection

The drugs you are prescribed must be injected into a vein carefully, so they don’t leak out of the vein and damage the skin. Some drugs are very damaging if they leak into the tissues.

If after you go home you develop a burning or painful feeling near where the drug was injected, telephone the hospital for advice immediately.

(Phone numbers at the front of this book).

Some treatments will cause a brown/red pigmentation on the skin above the vein where the drug is injected. This is harmless and will gradually fade with time.

Hair loss

Many patients associate the word chemotherapy with hair loss. It is often their biggest fear. However, many of the treatments that we use will not cause serious hair loss for most patients. More often they experience a little hair thinning. You may also lose some of your eyelashes, eyebrows and body hair.

Here is some useful advice to help prevent you from damaging your hair:

• Avoid using hairdryers and other heated styling tools

• Avoid hair spray, dye and perms

• Cut down on the number of times you wash your hair each week

• Use a gentle (pH neutral) shampoo and a conditioner

• Brush and comb your hair gently, using a soft hair brush or wide toothed comb

If you do experience hair loss it will happen about 2 weeks after your chemotherapy injections. The hair loss is temporary and will grow back completely after treatment is finished. You will usually see re-growth within 3 to 4 weeks.

If you lose your hair you may prefer to wear a hat, headscarf, turban or wig. If you would like a wig or turban, the chemotherapy staff, clinic nurses or Mustard Tree Support Centre staff can help arrange this.

Our wigs are currently supplied by Browns. Their salon can be located at Funky Fish, 47 Ebrington Street, Plymouth, PL4 9AA, Tel: 01822 610292. When the referral has been made by one of our hospital staff you will be contacted by Brown’s head office to arrange an appointment. They can offer a video appointment if that is preferred.   

Which drugs cause hair loss?

Some drugs: Doxorubicin, Epirubicin, Etoposide, Ifosfamide, Taxol and Taxotere are associated with severe hair loss. Other drugs can cause hair loss but it is dependent on the dose, the time taken to infuse the drug and the number of drugs used.

Your nurse will advise you further about this and more information can be found in the Macmillan leaflet about your particular regime.  

Scalp Cooling

This is where a cold cap is placed on the head during treatment. The coldness of the cap cools the cells in the hair root and restricts the blood flow to these cells. This causes the cells’ metabolism to slow down for a short while. They are then less affected by the circulating chemotherapy. This is not suitable for all types of chemotherapy treatment.

The cap is put on 30 minutes before treatment, the hair is dampened and conditioner applied to ensure good contact between the scalp and the cold cap. It remains on the head throughout the treatment and up to 90 minutes afterwards.

Scalp cooling significantly increases the length of time your treatment takes, but can be effective. In the Oncology Day Unit (Fal Ward) we use the latest equipment for scalp cooling called the Paxman Scalp Cooler. They have an informative website with details of the procedure, photographs of the cooler and details of cooling times at www.paxman-coolers.co.uk.

Fatigue (feeling exhausted all or most of the time)

Everyone has good days and bad days, but due to disease and cancer treatments nearly everyone will experience some fatigue.

Fatigue can mean more than being tired and weak. Other symptoms include leg pains, difficulty walking and climbing stairs, shortness of breath, difficulty concentrating and making decisions. This can sometimes continue for weeks or months after treatment is completed, making you feel irritable and low. It is important to rule out issues that might be causing fatigue like anaemia, poor dietary intake, pain or medication but there are techniques that you can adopt to help manage the symptoms.

The strategies below may help to combat fatigue and allow you to manage your everyday activities:

• Keeping a diary to monitor when you are most tired and when you have most energy

• Spreading tasks out over the week

• Prioritise your tasks so you can manage the more important ones

• Asking others to cook and shop for you, or use pre­cooked meals

• Regular light exercise has been recognised as one of the most effective ways of improving fatigue.

• Drinking plenty of fluids

• Using distraction techniques such as reading, visiting friends, listening to music

• Knowing when you have done enough.

For more information you can read ‘Fatigue’ by Macmillan, free to all cancer patients and carers. Your nurse can refer you to an Occupational Therapist, who can advise you on strategies to manage fatigue. You may also wish to speak to your specialist nurse if you have one.

Blood Clots

Cancer increases the chances of a blood clot (thrombosis) and chemotherapy can add to this risk. A clot can cause symptoms such as:

• Pain, redness and swelling in a leg

• Breathlessness

• Chest pain

If you have any of these symptoms, contact your doctor straight away. A blood clot is serious, but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.

Sexual relationships

Chemotherapy/SACT and the disease itself can affect sexual relationships. Some people may be unaffected by treatment whilst others have changes in levels of desire, changes in tolerance for physical activity and levels of fatigue. Anxiety and stress can also have an affect on sexual relationships.

Often people find that sexual activity is not important during treatment. However, once treatment is over and normal life resumes, couples can find that it is during this time they need support, advice, and information about resuming sexual activity.

Sexual feelings should return following treatment although time is required to allow you and your partner to come to terms with the changes and experiences you have been through. These are very natural feelings, and it is important to talk them through with your partner. If you are sexually active during the time you are on treatment, it is important not to become pregnant or father a child.  We would advise the use of condoms or some form of barrier contraception as an extra precaution to reduce a risk of further health problems, including infection for either partner.

Common Side Effects

Both men and women can experience a lowered libido or arousal difficulties while receiving SACT treatment which can be troubling for some patients. Talking to your partner about how you are feeling can also be difficult.

For men it is common to report erection difficulties and women report issues with pain.

There are a number of websites available which offer support and information for patients undergoing SACT treatment that can help with your concerns.

Cancer Research UK

Macmillan: cancer and your sex life

https://shinecancersupport.org/information/sex/ - information regarding cancer treatments and its affects.  Aimed at younger patients but still a good resource with podcasts, videos and how to obtain support.  Looks at physical, emotional and relationship issues.

Please discuss with your doctor or specialist nurse any matters relating to your sexual relations. If they cannot answer your questions they will be able to refer you to a counsellor or other health professional.  The Mustard Tree has additional resources that can offer support, including specialist psychosexual counsellors which you can access.

Fertility

Unfortunately, some treatments can cause infertility. This affect may be temporary or permanent depending on the particular treatment you are having. Your doctor will discuss this risk with you before treatment starts. Pregnancy should be avoided during treatment and for two years afterwards in case the drugs affect the developing baby. For this reason you should use a reliable method of contraception and speak with your consultant prior to planning a pregnancy.

For women

Some drugs may affect your ovaries and stop them producing eggs, although not all drugs will cause this to happen. If this does happen, it unfortunately means that you can no longer become pregnant; your periods will become irregular and eventually stop. It will also bring on symptoms associated with the menopause.

If your ovaries are going to start working again after treatment finishes (the infertility is short lived), your periods will return to normal. At present ‘banking’ of eggs is rarely practised, but you may wish to discuss this with your consultant before starting your treatment.

For men

Some drugs will have no effect on your fertility, but some drugs may reduce the number of sperm you have or affect their ability to reach and fertilize the female egg during intercourse. If the treatment does cause infertility, some men will remain infertile after treatment stops while for some sperm returns to normal levels.

If you have not completed your family you may be able to bank some of your sperm before treatment starts.  If this is possible you will be asked to produce several sperm samples, which will be frozen and stored. This can then be used later if necessary to make your partner pregnant artificially.

Your feelings

The very fact that you are having chemotherapy/SACT treatment for cancer is very daunting. All at once your whole life has been turned upside down. Future plans often have to be put on hold and you may feel that your life revolves around the hospital. We do understand this and will try to support you in whatever way we can.

Fear, anxiety, irritability, depression and changes in mood are all possible for patients being treated for cancer. Some people deal with this by being quiet and not talking about things, others find it helps to discuss their feelings with as many people as possible. Some want to know everything about their treatment and others very little, preferring to ‘leave it to the doctor’.

Loss of concentration may be a consequence of all these mixed feelings. You may find your mind wandering often. This can affect your ability to listen and recall what your nurses and doctors have said. If you miss something, do not be embarrassed to ask again what was said. You may find it useful to write down any questions you have regarding your treatment.

At the back of this booklet is a section entitled ‘Who can I talk to for advice?’ This gives information about our support services, and there is a list of useful addresses and websites.

Other matters

Tablets to take at home

You will be given medication to take home which can help with some symptoms that chemotherapy/SACT can cause.  These could be for nausea, diarrhoea and sometimes injections to support your immune system.  Keep your tablets in the bottle or blister pack that they come in. Store them in a cool, dry place, out of the reach of children. Some medications might need to be stored in the fridge.  Read the label carefully and please ask the doctor, nurse or pharmacist if you are unsure about how or when to take you medicine.

Is it ok to take other medicines and tablets?

Let your hospital doctor and / or your G.P. know if you are taking any prescribed medicines or tablets, as well as any you have bought from the chemist or health food shop. Please keep a list of all you medicines so that you can tell the doctor or nurse when you come to the hospital. If you do buy medicines at the chemists please tell the pharmacist what medication you are taking.

Continuous chemotherapy/SACT at home

Some patients, because of their particular disease may have continuous infusions via a pump into a tube in their veins. If you have problems with the equipment then you must telephone the relevant hospital department. You will have been given contact numbers before going home. The numbers are also at the front of this booklet.

If your pump, tube or syringe breaks, disconnects or leaks please clamp off the pump. Wrap the equipment in a plastic bag, telephone and come to the relevant department as soon as is practically possible. If any chemotherapy is spilt, use the spill kit that you should be provided with.  Wash the affected area and your hands thoroughly afterwards. Where possible do not allow any other family members / carers to handle the spillage.

General Information

Exercise

Research has shown that most patients undergoing cancer treatment benefit from gentle exercise and it can help to combat fatigue. This may vary from taking the dog for a walk to joining a low level exercise class.  However, it is important not to overdo it.

Work

It is entirely up to you whether you continue to work or not throughout your treatment.  Please discuss this with your consultant who will offer advice based on the work you do.  If you require any specific information on employment and your rights please speak with our Benefits Advisor in the Mustard Tree.

Driving

You do not need to inform the DVLA that you are receiving chemotherapy/SACT treatment.  We recommend that you do not drive to you first appointment as you may be affected by the treatment.  Some of the pre-medication drugs can cause drowsiness.  After your first appointment you must not drive if you feel unsafe or lacking in confidence.

Alcohol

If you are taking the chemotherapy drug Procarbazine, you must avoid alcoholic drinks, as well as low or non-alcoholic beers and lagers, during the course of capsules.

You may take small amounts of alcohol a few days after having other chemotherapy/SACT drugs, but you should check this with your doctor. Alcohol is dehydrating and you should make up for this by drinking more water or soft drinks as well.

Holidays

If you have planned to go on holiday when a treatment is due, please discuss this with your doctor, nurse or other member of staff. Your hospital doctor may delay a treatment until you return. Generally we will fit around your arrangements.

Many patients having treatment will be more at risk from sunburn. Some treatments make your skin more fragile or delicate. Some of the chemicals can make you more sensitive to the ultraviolet radiation of the sun. To avoid this, use a high factor sunscreen or cover up your skin.

Emergencies or problems Call the hospital if:

• You have a temperature of 37.5⁰C or more

• Shivering episodes

• Flu like symptoms or sore throat

• You have nose bleeds, bleeding gums, bad bruising, black tarry stools (motions), or any signs of unexpected bleeding

• Vomiting which is not relieved by your anti-sickness medication

• Watery diarrhoea which has lasted more than 24 hours

• Mouth ulcers that stop you eating and drinking

• Chest pain or difficulty breathing

• Your skin is painful, red or blistered near where the drug was injected

• You are having Capecitabine chemotherapy and your palms or soles become very sore and cracked

• You are receiving immunotherapy (nivolomab, ipilumumab, pembrolizumab and atezolizumab) treatment and experience any of the following:

• Breathing difficulties

• Diarrhoea or abdominal pain

• Tiredness, headaches, visual changes

• Skin rash

Please refer to the literature given to you by your CNS for further information and contact the hospital or CNS within 24 hours.

Call your G.P. if:

• You feel tired and breathless and look very pale (you may be anaemic)

• You are still constipated despite eating more fruit, vegetables and fibre

• You have other illness not related to your chemotherapy/SACT 

Which number should I telephone?

Oncology Patients

Only for unwell oncology patients or have a temperature please call: 01752 202082 and then ask for the oncology nurse on Bleep 0023 (available 24 hours a day)

Fal Ward: 01752 430290 or 430291

(For general enquiries Monday to Friday 9am to 5pm)

Oncology Outpatients: 01752 430983

(For general enquiries and oral chemotherapy blood results Monday to Friday 9am to 5pm)

Brent Ward: 01752 430043

(For general enquiries overnight and weekends)

Haematology Patients

If you are feeling unwell or have a temperature, please call:

01752 202082 and ask for the OPERATOR.  Ask the operator for the HAEMATOLOGY TRIAGE NURSE on Bleep 0228. This is available 24 hours a day.

Your call will then be answered by one of the haematology nurses. Please do not use this number for general enquiries. It is solely for the use of patients who are unwell and need advice.

Birch Day Case: 01752 432674 (Birch Reception) or 01752

432678 (Nurses Station) (For general enquiries Monday to Friday, 8.30am to 6.30pm)

Bracken Ward: 01752 432494

(For general enquiries)

Who can I talk to for advice?

If you were treated in the Oncology Centre at Derriford Hospital, you or your family can contact the Cancer Nurse Specialist (CNS) who helps with your type of illness. She/he will have given you a contact phone number at the beginning of you treatment.

If you were treated on Bracken Ward at Derriford Hospital, you or your family can telephone the ward on 01752 432494.

There are nurse specialists for many of the cancers such as:

Breast

Colon and rectum

Genito urinary tract cancers

Gynaecological cancers

Head and neck cancers

Leukaemia and lymphoma

Myeloma

      Lung

      Melanoma

      Neurological cancers

      Palliative care

      Sarcoma

      Upper gastro-intestinal tract (oesophagus, stomach, pancreas etc.)

The Mustard Tree Macmillan Centre

You may also visit the Mustard Tree Macmillan Centre on

Level 3 at Derriford Hospital. It is open 9.30am to 4.30pm, Monday to Friday, telephone 01752 430060.  This is our support and information service. It offers a number of services including counselling, financial advice, wig referrals, massage and reflexology. Since Covid 19 this is now an appointment based service. The centre is open to anyone affected by cancer patients, relatives and carers. People can use the centre at any period in their illness. All the centre’s services are free of charge with the exception of activities classes when a small charge is made.

My Sunrise App

The MySunrise App is an award winning free information resource designed specifically to support patients through their cancer treatment journey. This can be downloaded onto smart phones or tablet devices.

​​MySunrise has now being taken up across all NHS Cancer Centres in the South West with support from the NHS Peninsula Cancer Alliance.

​MySunrise provides a complete up-to-date information and reference tool for Cancer patients and their families, which guides and supports them through their cancer journey. It is complete with a whole range of videos, relevant links, cancer resources and contact information all specific to their own NHS Hospital cancer centre. 

Pastoral and Spiritual Care

No matter what your religious denomination, faith or even if you are not religious the hospital chaplaincy service is available to offer support or just a chat. Please ask a member of staff for contact details or visit the department on level 7 next to the hospital chapel.

Useful Websites

The following are just a few of the cancer related websites available on the internet. Many of them have further links to cancer information.

www.cancerhelp.org.uk  CancerHelp UK is the patient information website of Cancer Research UK.

www.christie.man.ac.uk  The website of the Christie Cancer Hospital with useful information on cancer and chemotherapy.

www.clic.uk.com Informative and useful links

www.macmillan.org.uk  A very comprehensive information service

www.mariecurie.org.uk  informative and useful links

www.nhsdirect.nhs.uk  Information and useful links

www.paxman-coolers.co.uk website for the company that makes our scalp coolers.

www.plymouthhospitals.org.uk  Our website, look for the Plymouth Oncology Centre in the departmental website section.

www.royalmarsden.nhs.uk  The website of the Royal Marsden Hospital with useful information on cancer and chemotherapy.