Systemic Anti-Cancer Therapies
Over the years the types of treatment that we use to treat cancer have grown and developed from, just traditional chemotherapy to include more targeted therapies and immunotherapy, these therapies are known as Systemic Anti-Cancer Therapies (SACT), all of which are delivered by our chemotherapy areas. Traditional chemotherapy is a type of cancer treatment where medicine is used to control the growth of cancer cells. It does this by damaging them so they cannot multiply and spread. Targeted therapy treats cancer by targeting the way cancers grow and divide. Immunotherapy encourages the body’s immune system to recognise and fight cancer. SACT can be given most commonly through an intravenous (in the vein), an injection under the skin, or oral (tablet) route. There are other routes that SACT can be given but these are not discussed here. SACT can be given to prepare patients for surgery or after surgery to reduce the risk of cancer recurrence or to control the spread of the cancer. The type of treatment you receive and the aim of your treatment will be guided by your oncologist (doctor specialising in cancer treatment).
We offer a SACT service at City Hospital and at King’s Mill Hospital. Our multi-disciplinary team of oncologists, pharmacists and chemotherapy nurses are highly trained and aim to provide treatment based on national and international guidelines and follow best practice.
The chemotherapy suite at Nottingham City Hospital and the oncology satellite unit at King’s Mill Hospital offer day case Systemic Anti-Cancer treatment, where patients do not have to stay in hospital overnight. If you are required to stay in hospital overnight for treatment, your oncology team will inform you when you are in clinic and organise for this to happen.
The chemotherapy unit team
The chemotherapy team is made up of
Basic information about SACT
- Systemic anti-cancer therapy consists of chemotherapy, immunotherapy, targeted treatments and antibody treatments. These may be combined to give the best available treatment for your cancer
- These can be administered intravenously as infusions, injections under the skin or as oral tablets.
- Your treatment will be chosen by your consultant oncologist based on your cancer type, treatment intent. Your consultant will outline the aims of your treatment and the treatment plan when you attend clinic. These decisions will be based on national/ international guidelines and the best available clinical evidence.
- If you have any questions about your treatment you should discuss these with your clinical nurse specialist or members of the team i.e. consultant, registrar, clinical fellow or oncology pharmacist.
- Some patients will be offered treatments within a clinical trial if this is clinically appropriate.
- Some patients will be offered SACT in tablet form. Your consultant will decide this based on guidelines and best practice. They will provide you with information and talk you through the side effects at your clinic review.
What are the opening times?
At City Hospital campus 8am-8pm [Monday – Friday]
At King’s Mill Hospital: Provides treatment on Wednesday and Thursday.
Where is the chemotherapy unit located?
At City Hospital:
- Intravenous Systemic Anti-Cancer treatments are administered on Chemotherapy Daycase. The chemotherapy daycase unit located in the south corridor at the City Hospital campus on the 1st floor. The best entrance to use is the South entrance. You can use the lifts or the stairs to get to the 1st floor.
- If your treatment is immunotherapy only then you could be treated on Lister 1 or chemotherapy day case. Lister 1 is located on the north corridor.
- If you are having treatment with tablets only then your care will be arranged in Oncology Outpatients and dispensed by Trust Pharmacy. Oncology outpatients is located on the ground floor on the south corridor.
- You will be informed in your appointment letter of the unit you will be treated on
Please see maps for further details
At King’s Mill Hospital: Clinic 9 at KMH is located downstairs from clinic 3.Lifts are available to the area on level –1.
Where do I park when I attend chemotherapy?
At City Hospital, the closest car parks are green and yellow, please note that these are pay and display/ pay on foot. www.nuh.nhs.uk/travel-by-car-and-parking-city
At King’s Mill Hospital, there is pay and display/pay on foot parking across the campus. The closest car park car park is in main entry with an option to use overspill car park at the other side of the road as you drive into KMH. www.sfh-tr.nhs.uk/for-patients-visitors/car-parking/
Can I take the bus to chemotherapy appointments?
At City Hospital, The Medilink drops you just outside of the south entrance
At King’s Mill Hospital, regular bus services run past the hospital see Trent or Stagecoach for times.
Am I allowed visitors on the chemotherapy unit?
At present, we are not allowing visitors to the chemotherapy suite due to COVID-19 restrictions. Please speak to the nurse in charge if there are extenuating circumstances. You must also wear a mask when entering our hospital.
Am I allowed to make a cup of tea/coffee on the chemotherapy unit?
Due to COVID, at Nottingham City Hospital we are unable to allow visitors use our kitchen to make drinks. The closest shop is located on the ground floor, towards the north corridor.
At King’s Mill Hospital there are usually volunteers on the unit to make drinks for the patients.
What happens before I start my first treatment with chemotherapy?
New Patient Interview (NPI): When you are referred for SACT by your consultant a chemotherapy nurse will carry out a new patient interview with you. This is currently being done via telephone so please ensure we have your up to date contact details. You may also be asked for an email address to be sent out information if being seen at King’s Mill Hospital. The interview involves a series of questions regarding what treatments you have been referred for, timescales, potential side effects/toxicities, contact details, current symptoms and a chance for you to ask any questions.
Following your NPI:
- You will be booked in for COVID swabs and blood tests
- Some patients will need an ECHO, MRI, blood tests, PICC lines. Your consultant will inform you if this will need to be completed before treatment starts.
- The consent form will be checked – if you have a copy please bring it along with you on the day of your treatment
- Do not forget to take any medications as advised at the NPI. Some treatments require you to take some medication before you first attend for chemotherapy.
- You will have an outpatient clinic review with the oncology team either, by telephone or face to face, a few days prior to your treatment
- You will have blood tests 2-3 days before chemotherapy. If you don’t hear anything this means that your treatment will go ahead and we will be calling you to attend for your treatment on the day (in the near future we will provide you with an appointment for your treatment and you can then attend at the appointment time). If there are any problems with your chemotherapy then you will get a call to explain what is happening and may be asked to have repeat blood tests if there are any problems with the results. The Pharmacy team will review your prescription to decide if your results are acceptable to proceed with your treatment. If you have blood tests too early these may not be helpful to the team to make decision.
What happens on the day I attend for SACT?
- On the day, at City Hospital you will get a call to confirm that your treatment has been prepared. Do not arrive at the unit until you have received a call. At King’s Mill, chemotherapy runs on an appointment based system.
- If you have an IV cannula inserted or if you have a PICC or a PORT catheter, this will be accessed.
- The chemotherapy nurses will confirm and administer you treatment.
How is chemotherapy prepared?
Once your intravenous anticancer treatment has been prescribed by your team and you have had your bloods taken, your treatment will be clinically checked by a specialist cancer pharmacist. Here, the pharmacist will check that this is an appropriate regimen and the doses are safe for you, checking against our protocols, your demographics (height, weight and age) and your bloods (including liver and kidney function). Once all relevant checks have been done, your prescription is signed off and sent to our Cytolab to prepare.
The Cytolab is a sterile Aseptic unit, ensuring that your treatment is made in an environment that is free from contamination caused by harmful bacteria, viruses, or other microorganisms. Once treatments are made, they have a maximum of 7 days until expiry, though some treatments expire after just a few hours and so the Cytolab plan to ensure your treatment is made in a timely manner and does not expire and go to waste. A lot of cancer treatments are very expensive and so are only made once the Cytolab have confirmation that you are fit and well for your treatment.
Who can I speak to if I have side effects from SACT?
It is also important to highlight that all the side effects from SACT are manageable but it is very important to tell your Oncologist any problems you have encountered so these can be addressed. You can also call your Clinical Nurse Specialist, if you have one.
If you have side effects from your SACT that you require advice on quickly or you have a rise in body temperature above 38c please call the rapid response line on 0115 9628066 you will be able to get advice 24 hours a day, 7 days a week including bank holidays.
What should I do if I have a rise in temperature i.e. a fever?
Chemotherapy causes myelosuppression. This means that your immune system may be weaker than normal and you may be more susceptible to infection. To reduce your risk of picking up an infection, please try to minimise your contact with family and friends who are unwell. One of the first signs of infection is a temperature; you will therefore need to buy a thermometer prior to starting SACT. The average person’s normal body temperature ranges from 36.1° to 37.2°C.
We ask that you check your temperature daily, roughly the same time everyday so you know what your normal body temperature is. Then the other occasion to check your temperature is if you are feeling unwell, for example, excessively tired, shaky, shivery or generally unwell. If you check your temperature and it is higher than 38c it is very important to phone the Rapid Response number straight away. If you are feeling unwell but your temperature is normal you still contact the Rapid Response number to be assessed.
What is a PICC line or a PORT catheter? If I have one, how do treat it
What is a PICC line or a PORT catheter? If I have one, how frequently do I have to have it flushed?
- Macmillan link for PICC lines and PORT catheters
- PICC lines need dressing and flushing weekly and this can be arranged
- PORT catheters if not being used regularly will need accessing on a monthly basis to be flushed
Can I get a wig voucher?
Wig/hat/scarf vouchers can be given for patients who are having treatment that causes hair loss. A voucher is offered towards a wig/hat/scarf and a factsheet will be provided with approved suppliers as the voucher isn’t accepted everywhere.
What is a cold cap?
Cold caps scalp cooling is where cold is used to reduce the amount of chemotherapy that gets to your scalp to try and minimise hair loss. Effectiveness of scalp cooling is very individual and will not work for everyone. It must be used on your first cycle of treatment and there are two methods of scalp cooling. The first is a shower cap which is put on your head and then a gel filled cap, which is kept in the freezer, is put on top and then an outer cap to secure everything. It goes on 15 minutes prior to starting treatment and changed every 45 minutes during treatment and is left on for 15 minutes after treatment.
The second method is using the Paxman which is a machine which keeps cold consistently. It is put on 30 minutes prior to treatment and stays on during. The cap stays on afterwards but the time will vary depending on the drugs you are having so can vary from 30 minutes up to 1 hour 30 minutes. Please speak to the chemotherapy nurses for more information. Paxman cools the scalp down to -5 degrees, which does carry some risk. Your consultant will establish whether the risks outweigh the benefits and provide you with the relevant information.
I am intending to travel abroad. What do I do?
In view of the COVID-19 pandemic, we will have to follow the guidelines outlined to us. If you are travelling to a country that requires you to complete a period of quarantine on your return, you will have to complete your quarantine prior to resuming on your treatment.
This is done to protect other patients and staff. You will be requested to have COVID swab prior to starting on treatment. Please discuss this with your consultant team and be aware of current government guidance.
Other places for support:
Maggie’s Centre they are now doing a session called getting started where you attend Maggie’s for a presentation and support contact details - www.nuh.nhs.uk/maggies-centre-nottingham
- Macmillan Cancer Information Centre situated on the Ground floor by Oncology Outpatients for support and advice
- CRUK – oncology information
If you have any concerns about side effects from chemotherapy or have a temperature above 38 C please contact the rapid response number. Advice is available 24 hours a day / 7 days a week including weekends and bank holidays.
If we don’t know, we can’t help you!