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Problem Solving in Acute Oncology

Second Edition

Problem Solving

in Acute Oncology

Second Edition

Edited by Alison Young, MBChB, MD, FRCP

Consultant in Medical Oncology, Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Ruth E. Board, BSc, MBChB, PhD, FRCP

Consultant in Medical Oncology, Rosemere Cancer Centre, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston

Pauline Leonard, MBBS (Hons), MD, FRCP

Consultant in Medical Oncology, Whittington Health NHS Trust, London

Tim Cooksley, MBChB (Hons), FRCPE

Consultant in Acute Medicine, Manchester University NHS Foundation Trust, Manchester; The Christie NHS Foundation Trust, Manchester

Andrew Stewart, BA, MBChB, MD, FRCPE, FRCPath

Consultant in Haematology, Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol; Weston General Hospital, Weston Area Health NHS Trust, Weston-super-Mare

Caroline Michie, MBChB, MRCP (UK), FRCPE

Consultant in Medical Oncology, Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh; Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh

Published in association with the Association of Cancer Physicians

E B N H E A L T H

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© Evidence-based Networks Ltd 2020 Second edition published 2020 First edition published 2014

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A catalogue record for this book is available from the British Library.

  • ISBN 13
  • 978 0 99559 543 9

The publisher makes no representation, express or implied, that the dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publisher do not accept any liability for any errors in the text or for the misuse or misapplication of material in this work.

Series design by Pete Russell Typographic Design, Faringdon, Oxon, UK Typeset by Thomson Digital, Noida, India Printed by Latimer Trend and Company Ltd, Plymouth, UK

Contents

Contributors Preface Acknowledgements

viii xiv xv

Abbreviations

xvii

SECTION ONE Perspectives

01 Acute Oncology Services: Past, Present and Future, Ruth E. Board

1

7

02 Nursing Developments in Acute Oncology, Jo Wilkinson,

Christine Rhall
03 Carcinoma of Unknown Primary, Pauline Leonard, Christine Rhall

11

04 The Oncology Patient in the Acute Medical Unit, Will Marshall,

18

Tim Cooksley

05 Which Cancer Patients Should Be Admitted to Critical Care?

22 28 31

Phil Haji-Michael

06 Acute Oncology Services in the Devolved Nations, Rosie Roberts,

Cathy Hutchison, Moyra Mills

07 Cancer Emergencies in the Community, Sinead Clarke,

Joanne Stonehouse, Joanne Wilkinson, Susan Jones

SECTION TWO Case Studies

Complications of Systemic Therapy

01 Febrile Neutropenia, Rohan Shotton, Amy Ford 02 Tumour Lysis Syndrome, Christopher Parrish, Gordon Cook 03 Antiangiogenic Therapy, Louise McKee, Gordon Urquhart 04 Cardiac Toxicity, Pankaj Punia, Chris Plummer 05 Liver Problems, Gemma Dart, Dan Swinson, Rebecca Jones 06 Acute Kidney Injury, Lucy Wyld, Christy Ralph, Andrew Lewington

37 47 52 59 64 72 78

07 Anticancer Treatment and the Kidney, Lucy Wyld, Christy Ralph,

Andrew Lewington
08 Metabolic Complications, Mahabuba Hossain, Carmel Pezaro,

84 89

Jennifer Walsh, Emma Rathbone, Janet Brown
09 Diabetes, Jenny Seligmann, Dan Swinson, Stephen Gilbey

vi Contents

10 Cutaneous Manifestations of Systemic Cancer Therapy,

96

Mehran Afshar, Laura Camburn
11 Acute Diarrhoea and Mucositis, Jordan Appleyard, Daniel Lee,

101

D. Alan Anthoney
12 Peripheral Neurotoxicity, Greg Heath, Susan Short, Helen Ford

108 113 117

13 Central Neurotoxicity, Greg Heath, Susan Short, Helen Ford

14 Chemotherapy-Induced Lung Toxicity, Lisa Owen,

Satiavani Ramasamy, Dan Stark, Martyn Kennedy

15 Metastatic Melanoma with Rash and Diarrhoea after Treatment

123 128

with Immune Checkpoint Inhibitors, Nadina Tinsley, Ruth E. Board

16 Side Effects of Complex Treatment of Metastatic Lung Cancer with
Chemotherapy and an Immune Checkpoint Inhibitor, Ajay Sudan,

Alastair Greystoke

17 Rare Immune-Related Adverse Events Associated with Immune

133 141

Checkpoint Inhibitors, Anna Claire Olsson-Brown

18 Complications of CAR T Cell Therapy, Adam Bond, Rachel Protheroe

Complications of Radiotherapy

19 Radiation Pneumonitis, Saif Yousif, P. Hadjiyiannakis

20 Radiation-Induced Head and Neck Mucositis, Arafat Mirza

148 153 160

21 Management of Radiotherapy-Related Acute Skin Reactions,

Deborah Williamson, Rachel Rigby

22 Toxicity Related to Pelvic Radiotherapy, Rohan Iype, Alison Birtle

169 172

23 CNS Toxicity of Radiotherapy, Simon Gray, Chin Chin Lim,
Catherine Mitchell

Complications of Cancer

24 Metastatic Spinal Cord Compression, Richard Heywood,

177

Vinton Cheng, Naveen Vasudev

25 Superior Vena Cava Obstruction, Rachel Bird, Jane Hook

26 Brain Metastases, Allison Hall, Pooja Jain, Andrew Brodbelt 27 Paraneoplastic Syndromes, Greg Heath, Susan Short, Helen Ford

183 187 194 199

28 Venous Thromboembolism, Nick Wreglesworth, Anna Mullard,
Helen Innes

29 Malignant Renal Obstruction, Andrew Viggars, Sunjay Jain,

205

Naveen Vasudev

Contents

vii

30 Management of Malignant Ascites, Benjamin Pickwell-Smith,

211

Alison Young
31 New Pleural Effusion, Keith Howell, Pooja Jain

217 225

32 Metabolic Complications of Malignancy: Hypercalcaemia,

Eliyaz Ahmed, Richard Griffiths, Sid McNulty

33 Metabolic Complications of Malignancy: Hyponatraemia,

229

Richard Griffiths, Sid McNulty
34 Bowel Obstruction, Gemma Dart, Alison Young

233 239

35 Malignant Pericardial Effusion, Madhuchanda Chatterjee,
Judith Carser, Nick Palmer, Chris Campbell, Simon Williams

36 Hyperviscosity Syndrome, Hyperleucocytosis and Leucostasis,

245

Nikesh Chavda, Andrew Stewart

Acute Palliative Care and Pain Control

37 Metastatic Small Cell Lung Cancer and Chest Wall Pain,

250 255

Tammy Oxley, Karen Neoh, Michael Bennett
38 Neuropathic Cancer Pain, Adam Hurlow, Michael Bennett

  • Index
  • 260

Contributors

Dr Mehran Afshar, Consultant in Medical Oncology, St George’s University Hospitals
NHS Foundation Trust, London

Dr Eliyaz Ahmed, Specialist Registrar in Clinical Oncology, Clatterbridge Cancer
Centre NHS Foundation Trust, Wirral

Dr D. Alan Anthoney, Consultant in Medical Oncology, Leeds Cancer Centre, St
James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Mr Jordan Appleyard, Medical Student, Barts and e London School of Medicine and Dentistry, Queen Mary University of London; Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Professor Michael Bennett, St Gemma’s Professor of Palliative Medicine, University of
Leeds, Leeds

Dr Rachel Bird, Staff Grade in Oncology, Leeds Cancer Centre, St James’s University
Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Alison Birtle, Consultant in Clinical Oncology, Rosemere Cancer Centre, Royal
Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston; Honorary Senior Lecturer, University of Manchester, Manchester

Dr Ruth E. Board, Consultant in Medical Oncology, Rosemere Cancer Centre,
Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston

Dr Adam Bond, Registrar in Haematology, Bristol Haematology and Oncology Centre,
University Hospitals Bristol NHS Foundation Trust, Bristol

Mr Andrew Brodbelt, Consultant in Neurosurgery, e Walton Centre NHS
Foundation Trust, Liverpool; Honorary Clinical Senior Lecturer, University of Liverpool, Liverpool

Professor Janet Brown, Honorary Consultant in Medical Oncology, Sheffield Teaching
Hospitals NHS Foundation Trust, Sheffield; Professor of Translational Medical Oncology, University of Sheffield, Sheffield

Dr Laura Camburn, Specialist Registrar in Medical Oncology, St George’s University
Hospitals NHS Foundation Trust, London

Dr Chris Campbell, Foundation Year 2 Doctor, e Christie NHS Foundation Trust,
Manchester

Dr Judith Carser, Consultant in Medical Oncology, Clatterbridge Cancer Centre NHS
Foundation Trust, Wirral

Dr Madhuchanda Chatterjee, Specialist Registrar in Clinical Oncology, Clatterbridge
Cancer Centre NHS Foundation Trust, Wirral

Contributors

ix

Dr Nikesh Chavda, Lymphoma Clinical Fellow, Bristol Haematology and Oncology
Centre, University Hospitals Bristol NHS Foundation Trust, Bristol

Dr Vinton Cheng, Specialty Registrar in Medical Oncology, Leeds Cancer Centre,
St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Sinead Clarke, GP Adviser, Treatment and Recovery, Macmillan Cancer Support,
London

Professor Gordon Cook, Professor of Haematology and Myeloma Studies, Leeds
Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Tim Cooksley, Consultant in Acute Medicine, Manchester University NHS
Foundation Trust, Manchester; e Christie NHS Foundation Trust, Manchester

Dr Gemma Dart, Registrar in Medical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Amy Ford, Consultant in Medical Oncology, Royal Lancaster Infirmary, University
Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster

Dr Helen Ford, Consultant in Neurology, Leeds Centre for Neurosciences, Leeds
Teaching Hospitals NHS Trust, Leeds

Dr Stephen Gilbey, Consultant in Endocrinology, Leeds Teaching Hospitals NHS Trust,
Leeds

Dr Simon Gray, Academic Foundation Doctor, Rosemere Cancer Centre, Royal Preston
Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston

Dr Alastair Greystoke, Senior Lecturer and Honorary Consultant in Medical Oncology,
Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne

Dr Richard Griffiths, Consultant in Medical Oncology, Clatterbridge Cancer Centre
NHS Foundation Trust, Wirral

Dr P. Hadjiyiannakis, Consultant in Clinical Oncology, Lancashire Teaching Hospitals

NHS Foundation Trust, Preston
Dr Phil Haji-Michael, Consultant in Anaesthesia and Critical Care, e Christie NHS
Foundation Trust, Manchester

Dr Allison Hall, Consultant in Clinical Oncology, Clatterbridge Cancer Centre NHS
Foundation Trust, Wirral

Dr Greg Heath, Consultant in Medical Ophthalmology, York Teaching Hospitals NHS
Foundation Trust, York

Dr Richard Heywood, Core Medical Trainee, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Jane Hook, Consultant in Medical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Mahabuba Hossain, Researcher in Clinical Oncology, Barisal Biotechnology UK
Ltd, Bangladesh

x

Contributors

Dr Keith Howell, Staff Grade in Oncology, Leeds Cancer Centre, St James’s University
Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Adam Hurlow, Consultant in Palliative Medicine, Leeds Teaching Hospitals NHS
Trust, Leeds

Dr Cathy Hutchison, Cancer Consultant Nurse, Beatson West of Scotland Cancer
Centre, NHS Greater Glasgow and Clyde, Glasgow

Dr Helen Innes, Consultant in Medical Oncology, Clatterbridge Cancer Centre NHS
Foundation Trust, Wirral

Dr Rohan Iype, Registrar in Clinical Oncology, Rosemere Cancer Centre, Royal
Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston

Dr Pooja Jain, Consultant in Clinical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Mr Sunjay Jain, Consultant in Urology, St James’s University Hospital, Leeds Teaching
Hospitals NHS Trust, Leeds

Dr Rebecca Jones, Consultant Hepatologist, Liver Unit, St James’s University Hospital,
Leeds Teaching Hospitals NHS Trust, Leeds

Ms Susan Jones, Macmillan Cancer Support Acute Oncology Clinical Nurse Specialist,
Mid Cheshire Hospitals NHS Foundation Trust

Dr Martyn Kennedy, Consultant in Respiratory Medicine, Leeds Centre for Respiratory
Medicine, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Daniel Lee, Consultant in Medical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Pauline Leonard, Consultant in Medical Oncology, Whittington Health NHS Trust,
London

Dr Andrew Lewington, Consultant in Renal Medicine and Honorary Clinical Associate
Professor, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Chin Chin Lim, Consultant in Clinical Oncology, Lancashire Teaching Hospitals
NHS Foundation Trust, Preston

Louise McKee, Specialist Pharmacist in Oncology, Aberdeen Royal Infirmary, NHS
Grampian, Aberdeen

Dr Sid McNulty, Consultant in Diabetes and Endocrinology, St Helens and Knowsley
Teaching Hospitals NHS Trust, St Helens

Dr Will Marshall, Clinical Fellow, Manchester University NHS Foundation Trust,
Manchester

Dr Caroline Michie, Consultant in Medical Oncology, Edinburgh Cancer Centre,
Western General Hospital, NHS Lothian, Edinburgh; Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh

Dr Moyra Mills, Macmillan Cancer Support Improvement Manager, Northern Health and Social Care Trust, Northern Ireland

Contributors

xi

Dr Arafat Mirza, Consultant in Clinical Oncology, Lancashire Teaching Hospitals NHS
Foundation Trust, Preston

Dr Catherine Mitchell, Consultant in Clinical Oncology, Rosemere Cancer Centre,
Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston

Dr Anna Mullard, Consultant in Medical Oncology, Betsi-Cadwaladr University
Health Board, Bangor

Dr Karen Neoh, Locum Consultant in Palliative Medicine, St Gemma’s Hospice, Leeds Dr Anna Claire Olsson-Brown, Fellow in Clinical Research, University of Liverpool,
Liverpool; Registrar in Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral

Dr Lisa Owen, Consultant in Clinical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Tammy Oxley, Specialist Registrar in Palliative Medicine, St Gemma’s Hospice,
Leeds

Dr Nick Palmer, Consultant in Cardiology, Liverpool Heart and Chest Hospital, NHS
Foundation Trust, Liverpool

Dr Christopher Parrish, Consultant in Haematology, St James’s Institute of Oncology,
Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Carmel Pezaro, Locum Consultant in Oncology, Sheffield Teaching Hospitals NHS
Foundation Trust, Sheffield; Yorkshire Cancer Research Senior Research Fellow, University of Sheffield, Sheffield

Dr Benjamin Pickwell-Smith, Registrar in Medical Oncology, Leeds Cancer Centre,
St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Chris Plummer, Consultant in Cardiology, Freeman Hospital, Newcastle upon Tyne
Hospitals NHS Foundation Trust, Newcastle upon Tyne

Dr Rachel Protheroe, Consultant in Haematology, Bristol Haematology and Oncology
Centre, University Hospitals Bristol NHS Foundation Trust, Bristol

Dr Pankaj Punia, Consultant in Medical Oncology, Queen Elizabeth Hospital,
University Hospitals Birmingham NHS Foundation Trust, Birmingham

Dr Christy Ralph, Consultant in Medical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Satiavani Ramasamy, Consultant in Clinical Oncology, Leeds Cancer Centre,
St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Emma Rathbone, Consultant in Medical Oncology, Calderdale and Huddersfield
NHS Foundation Trust, Huddersfield

Ms Christine Rhall, Macmillan Acute Oncology Lead Nurse, St Helens and Knowsley
Teaching Hospitals NHS Trust, Merseyside

Ms Rachel Rigby, Advanced Clinical Practitioner, Rosemere Cancer Centre, Royal
Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston

xii Contributors

Ms Rosie Roberts, Chemotherapy Specialist Nurse and Acute Oncology Project
Manager, Velindre Cancer Centre, Velindre University NHS Trust, Cardiff

Dr Jenny Seligmann, Clinical Lecturer in Medical Oncology, Leeds Cancer Centre,
St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Professor Susan Short, Consultant in Clinical Oncology, St James’s University Hospital,
Leeds Teaching Hospitals NHS Trust, Leeds; Professor of Clinical Oncology and Neuro-Oncology, University of Leeds, Leeds

Dr Rohan Shotton, Specialty Registrar in Medical Oncology, e Christie NHS
Foundation Trust, Manchester

Dr Dan Stark, Consultant in Medical Oncology, Leeds Cancer Centre, St James’s
University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds

Dr Andrew Stewart, Consultant in Haematology, Bristol Haematology and Oncology
Centre, University Hospitals Bristol NHS Foundation Trust, Bristol; Weston General Hospital, Weston Area Health NHS Trust, Weston-super-Mare

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    Contents Health .. .. .. .. .. .. .. .. Page 3 Education .. .. .. .. .. .. .. .. Page 7 Places to live .. .. .. .. .. .. .. Page 8 Work, money and benefits .. .. .. .. Page 10 Community Safety .. .. .. .. .. .. Page 11 Healthy living .. .. .. .. .. .. .. Page 12 Other help and support .. .. .. .. .. Page 17 This booklet has some useful telephone numbers and information. If you need to know more, please contact the Equality and Diversity Team, Town Hall, Weston- super-Mare, BS23 1UJ, telephone 01934 634 832, [email protected] 2 Gypsy and Traveller Services Information and Phone book October 2017 Health GP (your local doctor) To find out where your nearest doctor’s surgery is, call NHS Direct or Patient Advice and Liaison Service (PALS). NHS Direct Telephone: 0845 46 47 PALS North Somerset Telephone: 0800 923 2222 Clevedon Community Hospital Bristol South Walk-in Centre Minor Injuries Unit 5 Knowle West Health Park Old Street, Clevedon Downton Road BS21 6BS Knowle, Bristol, BS4 1WH Open: 7am – 9pm Telephone: 0117 903 0000 Telephone: 01275 872 212 Out of Hours Service If you need urgent advice about a medical problem when the Healthcare Centres are closed call Out of hours service 0845 121 0235 Emergency Services Accident and Emergency departments are for a serious illness or injury needing immediate treatment. Not all are open 24 hours. Accident and Emergency Weston General Hospital Grange Road, Uphill Weston-super-Mare, BS23 Telephone: 01934 636 363 Please note that A&E will be temporarily closed between the hours of 10pm and 8am. If you have an emergency, dial 999. Bristol Hospital for Sick Children Upper Maudlin Street, Bristol, BS2 8BJ Telephone: 0117 342 8344 Open 24 hours 3 Gypsy and Traveller Services Information and Phone book October 2017 Eye Hospital Dental Hospital Lower Maudlin Street, Bristol, BS2 8BJ Lower Maudlin Street, Bristol BS2 8BJ Telephone: 0117 342 4613 Telephone: 0117 923 0500 Open: 8.30am – 5pm, 7 days a week Open: 9.00am – 6.30pm, Monday to Friday Dentist Everyone has the right to visit a NHS dentist.