Acute Oncology What is it?

1. Acute Oncology What is it?

2. Overview of Acute Oncology Encompasses management of patients with severe complications following the treatment of, or as a consequence of their previously diagnosed cancer Management of patients who present as emergencies with previously undiagnosed cancer AOS brings together expertise from oncology disciplines, emergency medicine, palliative care, and general medicine and general surgery

5. Key Features of an Acute Oncology Service: (NCAG Report) Early review by an oncologist or oncology nurse specialist (within 24 hours) 24/7 access to telephone advice from an oncologist Fast track clinic access from A&E Access to information on individual patients across the Trust Protocols for the management of oncological emergencies and referral pathways from A&E and acute admissions unit Specific pathways for the investigation and treatment of malignant spinal cord compression

6. Acute oncology presentations • The following, as caused by the systemic treatment of cancer: • Neutropaenic sepsis. • • Uncontrolled nausea and vomiting. • • Uncontrolled diarrhoea. • • Complications associated with venous access devices. • • Uncontrolled mucositis. • • Hypomagnesaemia. • • Extravasation injury. • Acute hypersensitivity reactions including anaphylactic shock.

7. Acute oncology presentations The following, as caused by radiotherapy: • Acute skin reactions. • Uncontrolled nausea and vomiting. • Uncontrolled diarrhoea. • Uncontrolled mucositis. • Acute radiation pneumonitis. • Acute cerebral/other CNS, oedema.

8. Acute oncology presentations • The following, as caused directly by malignant disease and presenting as an urgent acute problem. • Pleural effusion • Pericardial effusion • Lymphangitis carcinomatosa • Superior superior vena caval obstruction • Abdominal ascites • Hypercalcaemia • Spinal cord compression including MSCC • Cerebral space occupying lesion(s)

9. Referral guidelines • The Acute Oncology Service is intended for ACUTE problems • It doses not replace existing pathways for the diagnosis of new • cancers or their planned treatment • During treatment and after treatment, patients and • GPs are advised to contact the original treating hospital. • All patients receiving chemotherapy and radiotherapy will have • been given the relevant contact numbers • GPs and patients will also be advised to refer to/attend their • local hospital/A&E department if patients present with immediate • life threatening complications

10. Assessment of treatment complications All patients should be issued with an alert card with 24 hour contact numbers. Chemo units should rehearse situations with patients to ensure that they understand when and who they should contact if they have a problem 9/15/2014 Philippa Jones Chemotherapy Redesign Manager, Greater Midlands Cancer Network 10

12. Triage Tool A tool that will determine “the patient’s level of risk” Prompt the practitioner with appropriate questions to ask in order to gain information from the patient Provide a reliable guide to toxicity/problem grading Prioritise the level of urgency indicated by the presenting symptoms and will aid in identifying potential emergency situations 9/15/2014 Philippa Jones Chemotherapy Redesign Manager, Greater Midlands Cancer Network 12

13. Triage Log sheet Contact Record It is vitally important that the data collection process is methodical and thorough in order for it to be useful and provide an accurate record of the triage assessment. A log sheet should be completed for all calls and unscheduled patient visits. This will facilitate audit of the helpline service. The Triage boxes MUST all be marked accordingly. IF YOU HAVEN’T TICKED IT,YOU HAVEN’T ASKED IT !!! 9/15/2014 Philippa Jones Chemotherapy Redesign Manager, Greater Midlands Cancer Network 13

14. Assessment tool RED- any toxicities graded here take priority and assessment should follow immediately. 2 AMBER-Two or more ambertoxicities should be escalated to red action and assessment should follow immediately.. Amber one toxicity in amber should be reviewed/ followed up within 24 hours and the caller should be instructed to call back if they continue to have concerns or their condition deteriorates Green callers should be instructed to call back if they continue to have concerns or their condition deteriorates. 9/15/2014 Philippa Jones Chemotherapy Redesign Manager, Greater Midlands Cancer Network 14

15. A patient has presented with an acute oncology problem Is it neutropenic sepsis? Could it be neutropenic sepsis? Do they need admission? How do you treat the complications of chemotherapy? Could their problem be dealt with by an early review in clinic? Can they be discharged? How can the Acute Oncology Service Help?

16. The Acute Oncology Assessment Service • Available Monday - Friday • Acute oncology specialist nurses • Access to consultant oncologist advice and assessment if needed • Malignant spinal cord compression co-ordinator • Telephone advice is available from a consultant oncologist, • 24 hours a day, seven days a week

17. CARCINOMA OF UNKNOWN PRIMARY Patient in A&E/ AAU Complication of known cancer IS THIS NEUTROPENIC SEPSIS >TREAT WITH ANTIBIOTICS< Acute medical review/ AOS review SPINAL CORD COMPRESSION Referral to AOS On active treatment Pericardial effusion Pleural effusion Brain mets Ascities Identified by alert MSCC co-ordinator/ On-call oncologist AOS review/ AO Specialist nurse Transfer to specialist ward Fast track protocols MRI scan Advice/review by Consultant Oncologist 24/7 Review in rapid access clinic/ acute oncology assessment unit Transfer to MSCC treatment centre Spinal surgeons/ Radiotherapy

18. Carcinoma of unknown primary (CUP) Most patients with newly diagnosed cancer are found to have a clearly defined primary tumour, and can then be swiftly referred on to a “site specialist team” 4% patients are found to have cancer without an identifiable primary site, despite exhaustive tests Because of the lack of dedicated clinical services, patients who have malignancy without an identifiable primary site can be denied the care offered to patients with site-specific cancers

19. North of England Cancer Network MSCC Centres NCC, Freeman Hospital James Cook Hospital Radiotherapy Centres NCC, Freeman Hospital James Cook Hospital Cumberland Infirmary

20. LOCAL PATHWAYS???? Which services at which hospital AOS team 24/7 chemo advice service Fast track clinics Consultant oncologist on-call service

21. Out of hours ?

22. Treatment protocols • Complications of the systemic treatment of cancer: • Neutropaenic sepsis. • • Uncontrolled nausea and vomiting. • • Uncontrolled diarrhoea. • • Complications associated with venous access devices. • • Uncontrolled mucositis. • • Hypomagnesaemia. • • Extravasation injury. • Remember there is an on-call oncologist available for • telephone advice at the cancer centre 24/7

23. Acute oncology presentations • The following, as caused directly by malignant disease and presenting as an urgent acute problem. • Pleural effusion • Pericardial effusion • Lymphangitis carcinomatosa • Superior superior vena caval obstruction • Abdominal ascites • Hypercalcaemia • Spinal cord compression including MSCC • Cerebral space occupying lesion(s)

24. In Hours Metastatic Spinal Cord Compression High level Pathway

25. In Hours Metastatic Spinal Cord Compression High level Pathway

26. Out of Hours Metastatic Spinal Cord Compression High Level Pathway

27. Out of Hours Metastatic Spinal Cord Compression High Level Pathway

28. LOCAL CONTACT DETAILS FOR SPINAL CORD COMPRESSION PATHWAY ??????

29. SUMMARISE LOCAL INFORMATION