1 Problem Solving in Acute Oncology Second Edition 00-EBN-FM.indd 1 1 30/09/19 11:21 AM 3 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 EBN HEALTH OXFORD, UK 00-EBN-FM.indd 3 3 30/09/19 11:21 AM 4 EBN Health An imprint of Evidence-based Networks Ltd Witney Business & Innovation Centre Windrush House, Burford Road Witney, Oxfordshire OX29 7DX, UK Tel: +44 1865 522326 Email: [email protected] Web: www.ebnhealth.com Distributed worldwide by: Marston Book Services Ltd 160 Eastern Avenue Milton Park Abingdon Oxon OX14 4SB, UK Tel: +44 1235 465500 Fax: +44 1235 465555 Email: [email protected] © Evidence-based Networks Ltd 2020 Second edition published 2020 First edition published 2014 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing from EBN Health or Evidence-based Networks Ltd. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to the attention in writing of EBN Health or Evidence-based Networks Ltd. EBN Health and Evidence-based Networks Ltd bear no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and do not guarantee that any content on such websites is, or will remain, accurate or appropriate. 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 00-EBN-FM.indd 4 4 30/09/19 11:21 AM 5 Contents Contributors viii Preface xiv Acknowledgements xv Abbreviations xvii SECTION ONE Perspectives 01 Acute Oncology Services: Past, Present and Future, Ruth E. Board 1 02 Nursing Developments in Acute Oncology, Jo Wilkinson, 7 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 Phil Haji-Michael 06 Acute Oncology Services in the Devolved Nations, Rosie Roberts, 28 Cathy Hutchison, Moyra Mills 07 Cancer Emergencies in the Community, Sinead Clarke, 31 Joanne Stonehouse, Joanne Wilkinson, Susan Jones SECTION TWO Case Studies Complications of Systemic Therapy 01 Febrile Neutropenia, Rohan Shotton, Amy Ford 37 02 Tumour Lysis Syndrome, Christopher Parrish, Gordon Cook 47 03 Antiangiogenic Therapy, Louise McKee, Gordon Urquhart 52 04 Cardiac Toxicity, Pankaj Punia, Chris Plummer 59 05 Liver Problems, Gemma Dart, Dan Swinson, Rebecca Jones 64 06 Acute Kidney Injury, Lucy Wyld, Christy Ralph, Andrew Lewington 72 07 Anticancer Treatment and the Kidney, Lucy Wyld, Christy Ralph, 78 Andrew Lewington 08 Metabolic Complications, Mahabuba Hossain, Carmel Pezaro, 84 Jennifer Walsh, Emma Rathbone, Janet Brown 09 Diabetes, Jenny Seligmann, Dan Swinson, Stephen Gilbey 89 00-EBN-FM.indd 5 5 30/09/19 11:21 AM 6 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 13 Central Neurotoxicity, Greg Heath, Susan Short, Helen Ford 113 14 Chemotherapy-Induced Lung Toxicity, Lisa Owen, 117 Satiavani Ramasamy, Dan Stark, Martyn Kennedy 15 Metastatic Melanoma with Rash and Diarrhoea after Treatment 123 with Immune Checkpoint Inhibitors, Nadina Tinsley, Ruth E. Board 16 Side Effects of Complex Treatment of Metastatic Lung Cancer with 128 Chemotherapy and an Immune Checkpoint Inhibitor, Ajay Sudan, Alastair Greystoke 17 Rare Immune-Related Adverse Events Associated with Immune 133 Checkpoint Inhibitors, Anna Claire Olsson-Brown 18 Complications of CAR T Cell Therapy, Adam Bond, Rachel Protheroe 141 Complications of Radiotherapy 19 Radiation Pneumonitis, Saif Yousif, P. Hadjiyiannakis 148 20 Radiation-Induced Head and Neck Mucositis, Arafat Mirza 153 21 Management of Radiotherapy-Related Acute Skin Reactions, 160 Deborah Williamson, Rachel Rigby 22 Toxicity Related to Pelvic Radiotherapy, Rohan Iype, Alison Birtle 169 23 CNS Toxicity of Radiotherapy, Simon Gray, Chin Chin Lim, 172 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 183 26 Brain Metastases, Allison Hall, Pooja Jain, Andrew Brodbelt 187 27 Paraneoplastic Syndromes, Greg Heath, Susan Short, Helen Ford 194 28 Venous Thromboembolism, Nick Wreglesworth, Anna Mullard, 199 Helen Innes 29 Malignant Renal Obstruction, Andrew Viggars, Sunjay Jain, 205 Naveen Vasudev 00-EBN-FM.indd 6 6 01/10/19 10:55 AM 7 Contents vii 30 Management of Malignant Ascites, Benjamin Pickwell-Smith, 211 Alison Young 31 New Pleural Effusion,Keith Howell, Pooja Jain 217 32 Metabolic Complications of Malignancy: Hypercalcaemia, 225 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 35 Malignant Pericardial Effusion,Madhuchanda Chatterjee, 239 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 Tammy Oxley, Karen Neoh, Michael Bennett 38 Neuropathic Cancer Pain, Adam Hurlow, Michael Bennett 255 Index 260 00-EBN-FM.indd 7 7 30/09/19 11:21 AM 8 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 The 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, The 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, The Christie NHS Foundation Trust, Manchester Dr Judith Carser, Consultant in Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Wirral Dr Madhuchanda Chatterjee,