Chemotherapy - Chemotherapy

Introduction

We hope that you and your family will find this leaflet a useful guide to chemotherapy. It will not answer every question about your treatment, nor is it intended as a substitute for discussion with the doctors and nursing staff. We hope that after you have read this booklet, you will find it easier to ask questions and to discuss your treatment and progress with us. There are more details about your individual treatment on the chemotherapy information sheet which your doctor will give to you.

What is chemotherapy?

Chemotherapy is a systemic anti-cancer therapy (SACT) which is used to treat cancer. Many types of medicines are used in chemotherapy, all of which attack cancer cells in different ways. For this reason, we often give several drugs in combination to increase the effectiveness of treatment. Chemotherapy can be used alone or with radiotherapy and/or surgery.

How does chemotherapy work?

The chemotherapy drugs, which can be given as an injection or as a tablet, circulate in the bloodstream and can affect cancer cells in all parts of the body. Cancer cells are rapidly producing other new cancer cells. Chemotherapy can interfere with the growth of cancers by preventing new cancer cells forming. Side effects from chemotherapy can occur because normal tissues in the body also rapidly produce new cells as a way of repairing themselves. These processes can also be temporarily affected by the chemotherapy. The commonest normal tissues that are affected are the hair roots (causing hair loss), bone marrow (causing low blood counts) and lining of the bowel (causing diarrhoea, constipation, nausea, and vomiting).

How often is treatment given?

This depends on the type of treatment you are having. In most cases, each chemotherapy treatment (or regime) is followed by a rest period of between one and four weeks. This is called a cycle. Depending on your condition and the reason for giving treatment, the total duration of chemotherapy varies. Your specialist team will discuss the details of your treatment with you.

Agreeing to treatment

Consent to treatment

We will ask you to sign a consent form agreeing to accept the treatment that you are being offered. The basis of the agreement is that you have had a written description of the proposed treatment and that you have been given an opportunity to discuss any concerns. You are entitled to request a second opinion from another doctor who specialises in treating this cancer. You can ask your own consultant or your GP to refer you. Your consent may be withdrawn at any time before or during this treatment. Should you decide to withdraw your consent, then a member of your treating team will discuss the possible consequences with you.

Benefits of treatment

The benefits of treatment will depend on the type of cancer you have and how advanced it is. The aims include:

• Curing the cancer. This is when chemotherapy is given to destroy all the cancer cells
• Reducing the chances of the cancer coming back, for example after surgery, by destroying any cancer cells that are still in the body but are too small to detect. This is often called adjuvant chemotherapy 
• Controlling the growth and spread of the tumour so that surgery or radiotherapy is easier to perform. This is often called neo adjuvant chemotherapy
• Controlling the growth and spread of the tumour which may slow down its progress and relieve symptoms. This is often called palliative treatment

Are there any alternatives to chemotherapy?

All treatments carry risks as well as benefits and thinking about possible options can help you decide what to do. Your doctor will discuss alternative treatments with you. These may include radiotherapy, immunotherapy, radiotherapy and chemotherapy given together, surgery or taking medicines to help with symptoms. It may also be an option to delay chemotherapy until symptoms occur.

What happens if you decide not to have chemotherapy?

There is a risk that your cancer may continue to grow and your symptoms may get worse. You can discuss what to do next with your doctor or your clinical nurse specialist.

How is chemotherapy given?

Chemotherapy can be given in different ways and your doctor will discuss the most appropriate option for you. This might include:

• By mouth as a tablet, capsule or liquid
• By injection into a vein using a device called a cannula. Treatment can be administered by hand (intravenous bolus) or through a drip (intravenous infusion). Treatment can also be administered as an injection directly under your skin (sub cutaneous) or by injection directly into a muscle (intramuscular). This treatment is usually given by a chemotherapy nurse and is no more painful than any other injection or blood test
• Central lines: some patients may need a central line (a central venous catheter). This is a fine tube which is passed into a vein in the chest. Central lines are usually put in under local anaesthetic and you may be offered a sedative. The line can be used both to take blood and to give chemotherapy and so reduces the need for needles
• PICC lines: PICC lines (peripherally inserted central catheters) are another type of central line placed in the arm and inserted under local anaesthetic. PICCs are mainly used for shorter periods of time or if people are not suited to other types of central lines
• TIVADs: A totally implantable vascular access device is a special type of central venous catheter. It is sometimes called a portacath®. A long hollow tube 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 the injection port, that sits underneath the skin on the chest. TIVADs are usually inserted under local anaesthetic but you may be offered sedation
• Infusion pumps: pumps are used to give an intravenous infusion of medicines over several hours or days. They are compact and easy to carry around – usually attached to a belt around the waist. This will require a central line

Some treatments consist of a combination of injections and tablets. In these cases, each cycle usually starts with an injection and is followed by the tablets which are taken at home for a period of up to three weeks.

Extravasation

Occasionally chemotherapy leaks outside the vein. This is called extravasation. With certain medicines this can be quite serious. We will do our best to minimise this, but if you develop pain during the injection, or afterwards around the site of the injection, please let the staff know, or if you are at home call F11 Hotline 0161 656 1166 immediately.

F11 Day Case Unit – What actually happens?

Not all patients attending the day unit are having chemotherapy, many other infusions and procedures take place on the unit.

General points

There are occasions when your treatment may have to be postponed if your blood results are not within our set ranges. We will tell you about this as soon as we can and arrange another appointment for you.

If there are any delays in the department

You may need to set aside the whole day for tests and treatment. If you have a long infusion or if there are delays for any other reason, you may not finish your treatment until well into the evening. This could result in an overnight stay in the hospital, although every effort will be made to complete your treatment as an outpatient. Alternatively, the day case unit is open till 8pm. If your treatment is likely to finish after this time, staff may arrange for you to come back the following day.

Staff will keep you updated on wait times in the department, where possible.

If you need to pick-up take-home medications, please be aware that Lloyd’s pharmacy can be very busy. Ward staff will usually ensure all your medication is collected from Lloyds and be ready for you when going home.

Visitors

There is restricted visiting on the inpatient ward, also restrictions are in place on the day case unit. Please speak to a member of staff if you need further information.

Very important

If you feel unwell on the day of your chemotherapy appointment and are too poorly to attend your appointment, you should call The F11 chemotherapy hotline 0161 656 1166 for advice. You may be advised to keep your appointment so that you can see a doctor. The doctor may decide to defer your chemotherapy or carry out further tests.

If you are due to have inpatient chemotherapy

• On the morning you are due to be admitted, please ring the inpatient ward to check if a bed is available for your admission
• In the event of no beds being available, we will keep you informed and try to get you admitted the following day/as soon as a bed becomes available

Behind the scenes

As you can see there are several steps involved in preparing and giving chemotherapy. It is not a quick process. We understand that the long waits can be tiring and frustrating.

Chemotherapy uses cytotoxic (anti-cancer) drugs to destroy cancer cells. This treatment requires several checks during preparation.

• First of all, your prescription is carefully checked in pharmacy
• The details of your prescription are double-checked. The chemotherapy is carefully made in a sterile area before the pharmacist makes a final check
• The chemotherapy is delivered to the treatment area and a final check is done by nursing staff

We hope this information has helped you to understand why at times you might have to wait for your treatment to start. It is a complicated procedure which can take time. It may seem that little is happening, but there is a lot of vital preparation going on behind the scenes.

Reasons why you may have to wait

• If your treatment is altered on the day
• If you must wait for the results of tests before your treatment can start
• For certain drugs your treatment will not be made up until the doctor or nurse confirms that the results of your blood tests are satisfactory. In this way, we try to avoid wasting expensive drugs which cannot be recycled or used for another patient. Other drugs do not keep long and would be wasted if not used quickly and will not be made up until the doctor or nurse confirms that the results of your blood tests are satisfactory. It can them take approx. 2 hours to make the chemotherapy
• Some teams of doctors are very busy with many patients needing treatment and/or consultations. We cannot tell how long each consultation will be. The length of time depends on each patient’s needs
• Some chemotherapy needs a ‘pre-med’ of drugs, taken up to 1 hour before starting the infusion. This is usually done to prevent a serious, life-threatening reaction to the chemotherapy

Do I have to be admitted to hospital?

Depending on the type of treatment, you may be able to go home on the same day as you are given chemotherapy. If you are having a short treatment of chemotherapy you can expect to be treated as a day case. For your first treatment, if you travel to hospital by car, it is a good idea for a relative or friend to drive you home again after treatment as you might feel unwell. At other times, if you feel able, you can continue to drive as normal. Some people need to stay in hospital for a few days. For some inpatients chemotherapy takes up only a small part of the day and you do not have to stay in bed.

Blood tests and the bone marrow

Once treatment has started, we take a blood sample before each cycle of chemotherapy. We need to check that your blood count is normal before you have the next cycle of chemotherapy. Blood count means the number of red blood cells, white blood cells and special cells called platelets in the blood. All these blood cells are made in the bone marrow.

All patients who are coming to F11 for chemotherapy, need their bloods to be taken, where possible 24 prior to appointment

Bloods can be taken at the following clinics (except bank holidays):

F11 Day case 8.30am - 11.30am, 5:30pm -6:45pm
Oldham (Lucy Pugh) 8.15am - 4.15pm
Fairfield 8.30am - 5pm
Rochdale 8.3am – 4.30pm

We know there will be some patients that will find this difficult please speak to a member of staff to make alternative arrangements

Chemotherapy can affect the bone marrow, causing a temporary fall in the number of these cells. Sometimes, treatment must be delayed by 1 or 2 weeks if your blood count has not returned to normal following the last cycle of treatment, as it would be dangerous to administer chemotherapy in these circumstances. If this happens, the delay does not reduce the effectiveness of your chemotherapy.

• Red blood cells give the blood its colour and carry oxygen from the lungs to all parts of the body; a reduction in the number of these cells is called anaemia. This can cause tiredness, breathlessness, and dizziness. A mild form of anaemia may result from chemotherapy, but this usually improves without any treatment. Sometimes, a blood transfusion is necessary
• White blood cells help to fight infection. When their numbers fall, the body’s resistance to infection is lowered. The white blood cell count usually recovers without any treatment, but the doctor may prescribe injections to aid recovery of the white cells
• Platelets are the cells needed to help your blood to clot. If the number of platelets falls, you may notice that your gums bleed when brushing your teeth. Nose bleeds can also occur and your skin may bruise more easily than normal. Sometimes a platelet transfusion is necessary, but the platelet count usually improves without any treatment

Other tests

Quite often we may need to check the function of other organs before starting chemotherapy. Depending on the results of these tests, treatments may sometimes have to be modified.

• Kidneys: Sometimes extra tests are needed to check your kidney function. This is sometimes carried out using a special kidney scan
• Heart: Certain chemotherapy medicines can affect the heart. The doctor will ask if you have any heart problems such as high blood pressure or angina. You may need some additional tests such as a heart scan (MUGA or echocardiogram) or a tracing of your heart (ECG – electrocardiogram)
• Liver: We will monitor how your liver is working from blood tests

Diabetes and cancer

If you have diabetes, it is important to tell your doctors and nurses.

Some medicines used for the treatment of cancer can alter blood sugar levels. Steroids, for example, may cause blood sugar levels to become high. So, you may find that while you are having treatment your blood sugar levels are not as well controlled as usual.

If you are an inpatient, it is important to tell the ward staff that you are diabetic, so they can offer you a suitable diet from the hospital menu. We may refer you to the hospital diabetic team.

If you experience difficulties in controlling your blood sugar levels when you are discharged, contact your own diabetes specialist nurse or GP for advice on the management of your diabetes.

Flu vaccinations

Is it all right for me to have a flu jab during the time I’m having chemotherapy?

It’s safe to have a flu jab but depending on the sort of chemotherapy you have had; it may not give quite as much protection against an infection as usual. Some patients may need two vaccinations. However, if you’re thinking of having any other vaccinations, do check with your doctor first, because some vaccines should be avoided.

Are there any side effects?

Chemotherapy affects some normal cells and when it does, side effects can occur. This section describes the common side effects you may have in the days and weeks after treatment and some of the things you can do to help. The side effects you have will depend on the particular medicine or combination of medicines you receive. Your doctor or nurse will discuss your proposed treatment with you and give you an information sheet which will describe the treatment and discuss the likely side effects. Your doctor or nurse will tell you what to expect. Some people do not get any side effects, but if they do happen, please tell the doctor or nurse, so that help can be given. Rarely, there is a chance that the side effects could be life-threatening. If you would like any further information, please discuss this with your doctor.

Infection

Most chemotherapy medicines reduce the body’s resistance to infection. Because of this, a minor illness can quickly develop into something more serious needing hospital treatment. Symptoms of an infection include a sore throat, cough, fever, or shivering.
We recommend that you use a digital thermometer so you can check your temperature if you think you have an infection or if you feel unwell. You can buy one from your local chemist or please ask a member of nursing staff as we can provide one prior to discharge. If you feel unwell, you have symptoms of an infection or your temperature is 37.5°C or above, or below 36°C contact F11 Chemotherapy hotline immediately on 0161 656 1166. Your nurse will give you full details of contact numbers during your first visit.

How you can help yourself to avoid infection

Most infections come from bacteria (germs) that we normally carry on our skin or in our bowel. They are harmless when the body’s ability to fight infection is normal. It is only when resistance is low that they can cause an infection.

MRSA stands for Methicillin Resistant Staphylococcus Aureus. It is a variety of a common germ called staphylococcus aureus which is found in the nose and throat of about a third of the population. People who carry this germ are said to be colonised with it. The germ causes no harm unless it spreads to a wound or gets into your body through another break in the skin when it may cause an infection. It can be passed to other patients causing them to be colonised or occasionally infected. The resistant form of MRSA can be quite difficult to treat.

Clostridium difficile is a bacterium (germ) that can cause infections in the bowel. The symptoms include abdominal pain, diarrhoea and sometimes fever. The bacterium is normally kept under control by other bacteria that live in the gut; however, some medications alter the conditions within the gut allowing Clostridium difficile to multiply. It then produces toxins that cause diarrhoea and can lead to severe inflammation of the bowel.

There are some things you can do to reduce the chance of infection:

General

• Maintain good personal hygiene
• While you are at the hospital, please wash your hands carefully. There is alcohol hand rub by each bed. It is quicker and easier to use than soap when your hands are not actually soiled but might be carrying ‘hidden’ bugs
• Please wash your hands with soap and water after using the toilet or if you have any diarrhoea
• Stay away from people who have a disease you can catch, such as a cold, the flu, measles or chickenpox. If you have not had chickenpox yourself and you come into contact with someone with chickenpox or shingles, get in touch with the chemotherapy hotline as action may need to be taken
• Be careful not to cut or nick yourself when using scissors, needles, or knives
• Use a soft toothbrush that won’t hurt your gums
• Don’t squeeze or scratch pimples
• Clean cuts and scrapes right away with warm water, soap and an antiseptic
• Wear protective gloves when gardening or cleaning up after animals
• Do not have any vaccinations without checking with your doctor

Dietary

• Good food hygiene is important. Remember to wash your hands before handling any foods and again after handling any raw foods. Don’t handle food if you are ill with stomach problems such as diarrhoea or vomiting
• Ensure all knives and utensils are clean before preparing food and cleaned again between use with raw and cooked foods
• Food should be stored safely in the fridge. Keep uncooked foods separate from ready-to-eat food. Store raw meat in a sealable container or on the lower shelf so it can’t drip onto other foods
• Raw meat such as beef, pork and chicken need to be cooked thoroughly. Cook until it is piping hot in the middle to ensure any food poisoning bacteria are killed
• Avoid take-aways and don’t re-heat ready-to-eat meals. Make sure all food is cooked thoroughly and is piping hot before serving
• Avoid all shellfish
• Please check that produce such as cheese and yogurt are pasteurised. Avoid unpasteurised cheeses (such as Brie and Camembert) and pâté as these may contain food poisoning bacteria
• Probiotic drinks such as Actimel, Yakult or supermarket own brands should not be drunk while you are having chemotherapy. It is also advisable to avoid bio-yogurts
• Avoid raw eggs. Use eggs with the British Lion stamp, as these may contain food poisoning bacteria
• Cooked egg dishes should be served immediately and eaten piping hot, as these may contain food poisoning bacteria

Nausea and vomiting

Some chemotherapy causes nausea (feeling sick) and/or vomiting. If this is likely with your treatment, you will be given an anti- sickness injection and tablets or medicines to take home. You may notice mild nausea but if you experience persistent nausea or vomiting, contact your GP or The F11 Chemotherapy Hotline for further advice. Otherwise, please tell your hospital doctor or nurse how you got on at your next visit. There are several anti- sickness treatments available, and if the first one you are given has not worked, we can usually find one that does work for you. During the first 24 hours after treatment, it is best to avoid heavy meals. Try light snacks instead and drink freely. It is best to avoid alcohol at this time. A loss of appetite for 24 hours or so after chemotherapy is quite common.

Loss of hair

Some medicines can cause hair thinning or even complete hair loss. You may also lose your body hair including eyebrows and pubic hair. Hair usually begins to fall out 10 to 14 days after treatment starts. This is normally only temporary and your hair will grow back when your treatment has finished. Very rarely hair loss can be permanent. Some people start to get their hair back before chemotherapy is over.

Your scalp may begin to feel tingly or painful. This is normal when the hair begins to fall out. Take simple painkillers such as paracetamol if needed. If the skin on your scalp becomes dry and itchy, using a plain moisturising cream can help.

You are entitled to a wig if your treatment causes you hair loss. It is a good idea to get your wig before you lose a lot of hair, so we can match it with your natural colour. Please speak to nursing staff or a member of the Macmillan Haematology nursing team. Our Macmillan cancer support worker can also support you with your referral.

Care in the sun

It is important to take special care in the sun. Some chemotherapy can make your skin more sensitive to the sun. Try to avoid too much exposure to the sun and sit in the shade when possible. Wear loose clothing and use a high factor sun cream. If you have lost your hair, remember to protect your head, ears and the back of your neck from the sun by wearing a hat.

Constipation and diarrhoea

Some chemotherapy can cause temporary diarrhoea or constipation. Please let your F11 doctor or nurse know if this occurs. You can be given medicine to help with this. Constipation can sometimes become a serious problem, so get it treated early. Changing your diet may also help.

Veins

When chemotherapy is injected intravenously, the veins can sometimes become hardened and sore or darker in colour. The veins will usually return to normal gradually. We can continue your treatment using other veins or a central line.

Sore mouth

To maintain a healthy mouth, clean your teeth twice a day using a medium small head toothbrush and fluoride toothpaste. Rinse your mouth thoroughly with water after cleaning.
 
Use a saline mouthwash to maintain a clean mouth. Make with a pint of cooled boiled water and a teaspoon of salt, use throughout the day to rinse the mouth.

We may recommend an antibacterial mouthwash four times a day. This can be prescribed by your GP or F11 doctor. Do not use commercial mouthwashes which tend to be harsh as they can dry and irritate the tissues.

If you develop a sore mouth, use the mouthwash four times a day if you can tolerate it. You can dilute the mouthwash with water. If your mouth becomes too sore, use water rinses instead as often as you find helpful – at least every two to four hours. Some people find sucking ice helpful. Avoid hot liquids and spicy foods, and drink plenty.

If the soreness fails to clear up quickly, this may be a sign of infection and you should contact your doctor or nurse for advice.

Fatigue

With some chemotherapy you may feel very tired. If you do, take more rest and try to get help with the housework. You may also want to take some time off work. If you need practical help at home, please ask the staff to refer you to a social worker.
However, it is beneficial to take gentle exercise as well as taking rest.

Other side effects

These only occur with certain medicines and include:

• Tingling or numbness in the tips of the fingers and toes
• Alteration in taste
• Hearing loss, ringing or buzzing in the ears
• Jaw pain
• Muscle aches and fever
• Watery eyes
• Dry, red and sore skin on hands and feet

If any of these effects are likely with your treatment you will be told beforehand. As with the other side effects of chemotherapy, they are usually temporary.

Feelings and emotions

Sometimes during chemotherapy, you may begin to feel anxious and on edge, or low and fed-up. This often improves as treatment progresses, but if you continue to feel like this, please let your doctor or nurse know as they can usually do something to help. Local cancer centres often offer counselling. Your Macmillan nurse can refer you to The Macmillan Information Centre who can refer you on to counselling services. please contact 0161 656 1026 . The Maggie’s Centre at Oldham has a clinical psychologist, please contact 0161 989 0550 or email oldham@maggies.org.

Fertility and contraception

Women

Menstrual periods often become irregular or stop during chemotherapy, but some women do remain fertile. It is very important, however, that you do not become pregnant whilst receiving chemotherapy because of the risk of damage to the baby. So, it is essential to use a barrier method of contraception. Once the treatment is over, your periods may not return to normal because chemotherapy can cause infertility. If you have any worries or questions about this, please ask the doctor or nurse. Please tell your doctor if you are using contraception in case there is a need to change it.

Men

Some types of chemotherapy cause infertility. If this is likely, your doctor will discuss the possibility of sperm banking before starting treatment. You may remain fertile during the early stages of treatment, but it is important that you do not father children whilst receiving chemotherapy because of the risk of damage to the baby. So, it is essential to use a barrier method of contraception. If you have any worries or questions about this, please ask the doctor or nurse.

It is very important to wear a condom during intercourse to prevent a pregnancy and reduce the risks of infection. It also protects your partner against transfer of chemotherapy in bodily fluids.

Chemotherapy and everyday life

Holidays: Before booking a holiday, please discuss this with your doctor as it may be better to wait until treatment is over. It is often possible to fit holidays in between cycles of chemotherapy, although it is not advisable to go abroad. As chemotherapy goes on working in the body for some time after treatment, it is best to wait for at least a month after your last treatment before going abroad.

Macmillan Cancer Support has up-to-date information about travel insurance for people being treated for cancer. Contact Macmillan Cancer Support on 0808 808 00 00 or call in at the Cancer Information Centre for an information leaflet.

Activities: Some people having chemotherapy are able to lead a normal life, carrying on their social life and continuing to work. Be guided by how you feel, but be sure to rest when you become tired.

Other tablets and medicines: Please make sure that the doctor knows about any tablets or medicines you are taking for other conditions, including any that you buy from the chemist. These can usually be continued unchanged during chemotherapy – but do check. We will send your family doctor full details of the treatment prescribed in hospital.
 
Alcohol: As a general rule, you may continue to drink a moderate amount of alcohol, but it is probably best avoided for the first 48 hours after chemotherapy. Certain medicines can react badly with alcohol and if your treatment includes these, we will tell you before starting.

Herbal remedies and health supplements

Some commonly taken supplements and herbal remedies can interfere with cancer treatments. Please tell your doctor about any supplements you may be taking, for example: vitamins, garlic capsules, cod liver oil, Echinacea and St John’s Wort. Your doctor may ask you to stop taking these while you are having chemotherapy.

Long term side effects

Some side effects may become evident only after a long time. However, your doctor can take action to avoid these for most patients, so the potential benefit you receive from treatment should outweigh the risks of serious long term side effects to the heart, lungs, kidneys and bone marrow. With some medicines there is also a small risk of an increased chance of developing another cancer. Sometimes the use of steroids and/or hormone treatment for breast and prostate cancer and the use of specific chemotherapy drugs can affect the strength of bones, causing thin bones (osteoporosis) and an increased risk of fractures. If any of these problems specifically applies to you, the doctor will discuss these with you and note this on your consent form.

Clinical trials

Research into new ways of treating all types of cancer is going on all the time. As no current cancer treatment is completely effective, cancer doctors are continually looking for new ways to treat the disease. These are called clinical trials and are the only reliable way of testing a new treatment. Often several hospitals in the country take part in these trials.
 
Before any trial can take place, it must have been approved by an ethics committee. Your doctor must have your written informed consent before entering you into any clinical trial. Informed consent means that you know what the trial is about, you understand why it is being conducted and you appreciate exactly how you will be involved.

In a randomised controlled clinical trial, some patients will receive the currently available treatment, whist others receive the new treatment, which may or may not prove to be better. A treatment is better either because it is more effective against the tumour or because it is equally effective and has fewer side effects.

So that the treatments may be accurately compared, the type of treatment a patient receives might be chosen at random (usually by a computer) and not by the doctor treating the patients. This is because it has been shown that if a doctor chooses the treatment or offers a choice to the patients, he or she may unintentionally bias the result of the trial.

Even after agreeing to take part in a trial, you can still withdraw at any stage if you change your mind. Your decision will not affect your doctor’s attitude towards you in any way. If you choose not to take part or if you withdraw from a trial, you will then receive the currently available treatment rather than a new one.

Our clinical trials are supported by a team of research nurses who can provide further information.

Outpatient prescriptions

Prescriptions are free for NHS patients in the hospital/Lloyds pharmacy. You may need an exemption certificate to get free prescriptions from a community pharmacy. Exemption certificates are available from the Macmillan Haematology nursing team, benefits advisers and your GP.

Appointments

Your chemotherapy is often made in advance of your arrival, which helps to reduce your waiting time. If you let us know of any appointment changes, we can prevent unnecessary wastage of medicines. Your co-operation and patience during busy periods is very much appreciated.

It is very important to keep your appointment for treatment wherever possible. If you do need to change or cancel your next appointment date, please contact F11 reception on 0161 778 5527/5515.

If you change your address or change your family doctor, please tell the receptionist where you are having chemotherapy.

Further information

Macmillan Cancer Support

This is a national charity which runs a Cancer Information Service. If you have questions about cancer or need support, you can ring the Cancer Information Centre at Oldham on 0161 656 1026.

Alternatively, there is a national Freephone number: 0808 808 00 00 (Monday to Friday, 9am–8pm). Textphone 0808 808 2121.
Specially trained cancer nurses can give you information on all aspects of cancer and its treatment.

They publish leaflets which are free to patients, their families and carers. You can get a copy by ringing the freephone number. The information is on their website: www.macmillan.org.uk

Macmillan Cancer Support booklets include:

Specific cancers, for example, lymphoma, myeloma, leukaemia. Cancer treatments such as ‘Understanding chemotherapy’ and ‘Understanding radiotherapy’. Booklets on living with cancer – some are listed below:

• Talking about your cancer
• Coping with fatigue
• Talking to children when an adult has cancer
• Coping with hair loss
• Cancer and complementary therapies
• Bone health

The Cancer Information Centre also has a full range of Macmillan leaflets, please ring 0161 656 1026.

Benefits and Finance

You may have had to stop work and had a reduction in your income. You may be able to get benefits or other financial help. Personal Independence Payment (PIP) is a social security benefit and has replaced Disability Living Allowance (DLA) for new claimants. It’s for people who need help either because of their disability or their illness. You can apply if you are aged 16–64.
People aged 65 or over who need help with personal care or supervision could be entitled to Attendance Allowance. Your carer could get Carer’s Allowance if you have substantial caring needs.

Find out more today:

• To get a claim pack for Attendance Allowance, call 0345 605 6055 and for PIP call 0800 917 2222
• Carer’s Allowance: call 0345 608 4321
• For benefits advice, contact Maggie’s Centre on 0161 989 0550 or email oldham@maggies.org
• Macmillan Information Centre 0161 656 1026
• Contact your local social services department for help with equipment and adaptations, or for an assessment of care needs. Visit www.gov.uk for further information
• Macmillan Cancer Support can give advice on helping with the cost of cancer on 0808 808 0000 or www.macmillan.org.uk

Urgent contact number

F11 24hr Chemotherapy hotline on 0161 656 1166.

Useful contacts

F11 Day Case reception: 0161 778 5527/5515 (8am – 8pm)
Appointments and transport enquires

Macmillan Haematology Clinical Nurse Specialist Team:

Telephone: 0161 778 5297
Monday - Friday 9:00am - 5:00pm

Your consultant is .................................................................

Your hospital no. is ...............................................................

Useful contacts

F11 Day case reception: 0161 778 5527/5515 (8am – 4pm)
F11 Day case nurses station: 0161 778 5584/5586 (8am – 6pm)
F11 Inpatient nurses station: 0161 778 5514/5519 (24hrs)

Macmillan Haematology Clinical Nurse Specialist Team:

Telephone: 0161 778 5297
Monday - Friday 9:00am - 5:00pm

Your consultant is .................................................................

Your hospital no. is ...............................................................