chemotherapy training programme v. 3 · mentorship certificate. the student will be reminded that...

Chemotherapy Training Programme V. 3.0 – Approved May 2014 of 48

Chemotherapy Training Programme V. 3.0

Author: Chemotherapy Nurses Group

On behalf of the Chemotherapy CNG

Agreed: September 2007, September 2009 & May 2014

Review: May 2017

Chemotherapy Training Programme – Revised February 2014 of 48

Introduction

This training programme has been developed by the Network Chemotherapy Nurse’s group, in collaboration with the Chemotherapy Clinical Network Group, in response to the need to meet the demand of training issues for chemotherapy practitioners, across the Network. The structure of the training programme has been developed in line with the Royal College of Nursing IV therapy competencies, the National Chemotherapy Advisory Group and Skills for Health chemotherapy competencies and is aimed at qualified nurses wishing to undertake chemotherapy administration. The expectation is that the programme, which is work based and includes specific training common to all types of chemotherapy delivery, will be used locally by the named trainer for the clinical chemotherapy service. This will promote a standardised approach to training in chemotherapy delivery across the Cancer Network and comply with the Manual of Cancer Services quality measures. It is recognised that some aspects of the programme may not be applicable in specific patient groups i.e. paediatrics and local adaptation may be necessary. In standardising the training and assessment of chemotherapy delivery, it is anticipated that practitioners will be able to demonstrate their level of skill through a “declaration of competency” which will be transferable across Cheshire Merseyside & Strategic Clinical Network. The Chemotherapy Nurses Group and Chemotherapy CNG accept that meeting the training needs for chemotherapy delivery is an onerous commitment for the clinical chemotherapy service; the programme has been developed as a practical solution to assist this process. The programme is intended to be used as a foundation prior to further academic study. Signed Signed Rosie Lord Mike Varey Chair Chemotherapy CNG Chair Chemotherapy Nurse Group The Network would like to acknowledge the input of both Angela Madigan & Emma Carrick in the original development of this training programme.


CONTENTS PAGE

1. Programme content 4

2. Overview of the assessment process 6

3. Education Programme Content 7

4.

Chemotherapy Delivery Competency Framework

4.1 Competencies

4.2 Guidance on assessing competency

13

13

14

5.

Competency Assessment

5.1 Declaration of competency

26

36

Appendix 1 Recommended further reading 37

Appendix 2 Glossary of terms 38

Appendix 3 UKONS Triage Tool 48


1. Programme Content

Registered practitioners required to deliver chemotherapy must, within the scope of professional practice, have

Expanded their scope of professional practice into the administration of cytotoxic agents Been assessed as competent in the safe handling of cytotoxic agents

The training programme to support the safe delivery of chemotherapy will be a 12-week practical competency based package in the administration of cytotoxic chemotherapy (THIS DOES NOT ADDRESS THE USE OF INTRA-THECAL CHEMOTHERAPY). The programme will include 6 study days over the 12-week period to be delivered by the named nurse trainer(s) for the clinical chemotherapy service. It is advised that each cohort consist of no more than 3 students at a time on any one ward. The content of the study days will address:

Phlebotomy and cannulation skills - Infection control - Why it is necessary - Practical assessment 10 successful attempts at both - Trust policy

Cancer biology and why we give chemotherapy

- Basic cell biology - Classification of chemotherapy (drug groups) - Targeted therapies

Routes of administration

- Intravenous Infusions - Bolus chemotherapy - Volumetric pumps - Oral chemotherapy

Safe Handling of cytotoxics

- Safe handling of cytotoxics - Protective equipment - Spillage


- Disposal of chemotherapy - Trust Policies

Side effects

- UKONS triage tool

Adverse Reactions - Extravasation - Anaphylaxis

Central vascular access devices (PICC/Tunnelled)

- Infection control issues - Assessment for the correct catheter for the correct patient - Trust Policy

Holistic Assessment

- personalised care - holistic care - choice in care

Cancer related complications

- Physical complications of cancer Prior to commencing the programme students should have attended local venepuncture and cannulation course. The programme will act as a learning tool to ensure safe practice in the administration of chemotherapy drugs, reducing the potential for harm to both patient and staff, whilst maintaining staff competencies. Each student must be allocated a designated mentor who works with the student at least 50% of the working week. This would offer continuity and support to the student. The mentor must hold a recognised chemotherapy certificate and appropriate mentorship certificate. The student will be reminded that they will still be accountable for their practice as detailed in NMC Standards of conduct, performance and ethics for nurses and midwives (2010) i.e. “as a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions.” 2. Overview of the Assessment Process


On successful completion of the programme the nurse will be awarded by the named trainer for the chemotherapy service, a declaration of competency in the administration of chemotherapy. The practitioner will hold a copy within their personal profile and the trainer will maintain a record locally. The declaration will be recognised across all Trusts within Cheshire Merseyside & Strategic Clinical Network. Prior to being assessed as competent to administer cytotoxic agents, it is vital that the student is able to: Identify the implications of the NMC Standards of conduct, performance and ethics for nurses and midwives (2010) Identify and understand the implications of legal and professional issues relevant to administering cytotoxic chemotherapy Identify, understand and apply the theoretical knowledge underpinning the clinical skills required to administer cytotoxic

chemotherapy Demonstrate a clear understanding of the correct procedure for administering cytotoxic chemotherapy Demonstrate knowledge of the documentation required for all patients receiving cytotoxic chemotherapy Identify the pharmacological properties of cytotoxic substances and understand their implications for the administration of

cytotoxic chemotherapy If the student does not fulfil all of the above criteria it is his/her responsibility to contact his/her assessor in order to discuss how competency may be achieved. Competency Assessors Members of the clinical chemotherapy service who administer chemotherapy should be assessed by: Chemotherapy trained nurse band 5 or above (supported by a band 7) Completed the trust / network chemotherapy training programme or equivalent Routine involvement with administering chemotherapy Stage 2 mentor The assessor must be currently authorised as competent in the areas they are assessing Re-assessment & Peer Review Requirements Updates and assessment should be maintained annually as a minimum requirement and more frequently when changes in practice have been indicated (e.g. updated research/ government guidelines, new drugs and/or administration techniques) and where the practitioner is not regularly using this method of cytotoxic administration, as stated in Manual for Cancer Services: Chemotherapy Measures Version 2.0 (2013) 11-3s-116/117/118/119. NB: Accessing annual competency assessment for administration of chemotherapy is the individual responsibility of the practitioner.


3. Education Programme Content

3.1 Teaching sessions Aims and objectives The following aims and objectives are the agreed content and expected outcomes for each teaching session; it is the lead chemotherapy nurse and lead chemotherapy trainer responsibility to format these teaching sessions according to their trust format and organise appropriate delivery to the students. The list is not exhausted but the following aims and objectives must be included into the teaching sessions to offer consistency to all students across the network.

Pre Course Requirement – Local Trust phlebotomy & cannualation training course completed.

Phlebotomy

Aims The Registered practitioner undertaking this training must take responsibility and have an awareness of the relevant Trust policies, procedures, NHS guidelines and directives as well as the Health and Safety issues. The aim of this training is for the individual to become a confident and competent practitioner. Registered practitioners are personally accountable for their own practice and must maintain their professional knowledge and competence.

Demonstrate appropriate infection control principles when performing phlebotomy Use of appropriate system to collect blood sample e.g. butterfly or vacutainer The anatomy and physiology of the arm List the potential complications during and after taking blood Professional accountability Technique competency.

Intravenous cannulation for the administration of cytotoxic chemotherapy

Aims The Registered practitioner undertaking this training must take responsibility and have an awareness of the relevant Trust policies, procedures, NHS guidelines and directives as well as the Health and Safety issues. The aim of this training is for the individual to become a confident and competent practitioner. Registered practitioners are personally accountable for their own practice and must maintain their professional knowledge and competence.

Objectives


An understanding of the anatomy and physiology related to cannulation for the administration of cytotoxic therapy. An awareness and appreciation of the appropriate current literature pertaining to administration of cytotoxic therapy. An awareness and understanding of the different routes of administration of cytotoxic chemotherapy. A competency to care for the patient holistically. To identify the correct size cannula to insert and into which vein. To prepare the patient and gain informed consent. To select the appropriate equipment necessary for the procedure. To be able to demonstrate through supervised practice the ability to safely cannulate a patient for treatment. To describe the potential complications of cannulation and how to avoid and rectify them.

The Biology of Cancer

Aims The aim of this educational session is to build on pre-existing knowledge of the cell cycle, to understand how a malignant cell is structured and organised so that the student can develop an understanding of how the cell may develop and act. By giving the student a greater insight into what cancer is, students will have better understand of the effects of cancer and chemotherapy therefore providing research based comprehensive care. This will be achieved by providing the students with a research based educational session looking at the following: Incidence of cancer Cell cycle and reproduction Structure and Organisation


Route of Administration

Aims The aim of this session must provide the student with a detailed overview of different routes of administration. In this session the student must be reminded that this training package does not equip them with intrathecal chemotherapy training for the nurse to receive this training they must complete their trusts intrathecal training programme, it is recommended that nurses have at least 12 months chemotherapy administration experience before completing their local intrathecal training. In-depth teaching around intravenous chemotherapy – bolus and infusion and oral chemotherapy should be given. If continuous infusional chemotherapy is used within the working area the student needs to understand why and how this is administered. Oral cytotoxics: The increasing emphasis on developing oral agents is an important factor when considering the future care of cancer patients it is critical that patient education is thorough so that patients understand:

Why they are taking their tablets How many tablets to take, how often and for how long The potential side effects of treatment How to recognize toxicity and What to do if they feel unwell.

For home-based therapy to be successful, it is vital that patients’ take an active part in their care. Most oral chemotherapy is taken over a protracted period of time; the responsibility to recognise and report any side effects rests with the patient. Therefore patient education must emphasise recognition of early signs and symptoms and ways to report problems, as well as information to assist patients in preventing exacerbations. A brief overview of other routes of administration intravesical, intramuscular, subcutaneous, limb perfusion, intro-serous cavities & topical should be provided as relevant to local clinical chemotherapy service.

Safe Handling of Cytotoxics

Aims The student should be able to identify the risks of dealing with cytotoxics and how to handle them to minimize these risks. Use all local trust policies applicable to this subject.

What is the risk – Mutagenic, Teratogenic, Carcinogenic Routes of absorption – Inhalation, Absorption, Ingestion


How to minimize exposure – safety equipment Safe handling techniques for administration – tips of the trade! Handling and disposal of cytotoxic waste Spillages

Side Effects and Adverse Reactions

Aims The aim is for the student to demonstrate knowledge and management of chemotherapy induced side effects and adverse reactions. The teaching session should equip the student in identifying the cause and evidence based care in relation to the management of side effects of chemotherapy. Discuss the information of the patient and carers throughout the chemotherapy journey. All local trust policies for these should be incorporated into the teaching session.

Chest pain Nausea Vomiting Oral/stomatitis Diarrhoea Constipation Fever Infection Palmar-plantar syndrome Fatigue Anorexia Dyspnoea/shortness of breath Rash Neurosensory/motor Bleeding Pain Bruising Extravasation Bone marrow depression Alopecia Stomatitis/mucositis Nausea and vomiting Fatigue Diarrhoea and constipation Extravasation


Central Vascular Access Devices (PICC/Skin Tunnelled)

Aims The aim of this teaching session is that the student can develop a deeper understanding of the different types of central lines used in the clinical area and how to care for them. The teaching session should explicitly explain the following: Different devices and why they are chosen What groups of patients have these devices? Infection control issues How to redress and flush a Peripherally Inserted Central Catheter (PICC) How to redress and flush a Skin Tunnelled Central Catheter How to take a blood sample from a PICC How to take a blood sample from a Skin Tunnelled Central Catheter Recognition of CINS group and protocols for the care and maintenance of central catheters Care of portacaths and midlines if appropriate to the student’s area of work.

Holistic Assessment

Aims The aim is for the student to develop and enhance their nursing assessment skills, this will be achieved through the continuing development of their communication skills and enhancing of their knowledge of problems which are experienced by patients receiving chemotherapy & understanding of the range of services available locally to signpost patient/carers to for additional support. Objectives The process supports the following principles for patient-centred care:

personalised care ; i.e. care organised around the felt and expressed needs of individual patients and carers, which is delivered (via speech and action) with sensitivity, compassion and respect for the dignity of the patient and carer;

holistic care; i.e. care which not only meets the health/clinical needs of the patient, but which also addresses wider emotional, practical, psychological and spiritual concerns arising from the cancer patient's diagnosis, treatment and after-care;

choice in care: i.e. care consistent with the patient's and carers' choices concerning their involvement in decision-making about their treatment and care.

Cancer related complications

Aims


The aim is for the student to demonstrate knowledge of physical complications of cancer and the associated management/pathways. The teaching session should equip the student in identifying the signs & symptoms of common cancer related complications Objectives The teaching session should explicitly explain the following:

MSCC and network pathway. SVCO and treatment pathway Signs and symptoms of neutropenia and treatment pathway Signs and symptoms of tumour lysis and treatment pathway Chemotherapy late effects Local acute oncology service including role & contact points


4. Chemotherapy Delivery Competency Framework

4.1 Competencies

1. Phlebotomy

2.. Cannulation

3. Biology of cancer

4. Routes of administration

5. Safe handling of cytotoxics

6. Side effects

7. Adverse Reactions - extravasation

8. Adverse Reactions – anaphylaxis

9. Central vascular access devices - PICC

10. Central vascular access devices – Skin tunnelled catheter

11. Holistic assessment

12. Cancer related complications


4.2 Guidance on Assessing Competencies

The following offer some guidance on the criteria, which should be considered when assessing competence. These points are not exhaustive and should be used as prompts only.

Chemotherapy competency Points to be considered

Competency 1 & 2: Undertakes successful cannulation of patients via peripheral route/ Undertakes successful phlebotomy

As per competency assessment p.xxxx Observed technique.

Assessors should ensure student as successfully completed Trust cannulation & phelobotomy training


Competency 3: The Biology of Cancer. Why do we give chemotherapy?

Briefly explains the phases of the cell cycle. Discusses the effects of cytotoxic drugs on the cell.

Brief understanding of cell cycle and how this relates to drug classification. Learners should understand the difference between phase specific and phase non-specific drugs. Basic understanding of different modes of action of chemotherapy drugs.

Student should be able to identify the key stages of the cell cycle. Go, resting phase (chemo not active in this stage), G1, S synthesis of DNA, G2, & M mitosis cell division & growth. Chemotherapy most active in dividing cells. Phase specific drugs only kill cells in specific phase of the cell cycle. Example: 5FU, methotrexate active in the S phase. Vinka alkaloids (Vinblastine, vinoralbine) & Taxanes (Docetaxol, Pacitaxol) active in the mitosis stage. Non phase specific drugs can kill the cell at any phase of the cell cycle.


Outlines common drug regimens found within own clinical area including sequencing.

Demonstrates knowledge of the drugs/regimens to be administered. Understands the regimen and knows how often cycles are repeated. Provides explanation / educates patient.

Ask student to identify at least two common regimes, how they are given, how often they are repeated & what key information both verbal and written would be given to the patient. Recognises implications of administering chemotherapy via the incorrect route. Student can identify some of the different routes used in oncology to deliver chemotherapy. For example oral, central, peripheral administration of drugs. If a student is working in Oncology they must complete the capecitabine training attached with this programme.


Competency 4: Routes of administration

Discusses principles of practice when administering chemotherapy e.g.

- type of equipment used - sequencing of bolus drugs - patient positioning - methods used to achieve vasodilation - use of scalp coolers.

Distinguishes between timings of vesicant, irritant and non-irritant chemotherapy. Explains choice of environmental and intravenous equipment, patient positioning, and infusion fluid. Demonstrates awareness of environmental factors which could contra-indicate the appropriateness of chemotherapy delivery. Discusses use of aids to practice, such as scalp-coolers and methods to achieve vasodilatation.

Student has an understanding that vesicants are administered first after the anti-emetics, always checking venous return and a good flow rate of IV fluids. Ensure the patient is comfortable, arm supported, and repeatedly checking comfort, venous return and flow rate.

Scalp coolers used, with the aim to prevent alopecia with certain


drugs. Demonstrate awareness of why scalp cooling is not offered to the haematology patient.

Identifies chemotherapy with irritant and vesicant properties.

Identifies bolus chemotherapy with irritant and vesicant properties. Recognises implications of this information with respect to extravasation.

Can identify which drugs are vesicants, which are irritants (or can identify where they could find this out). Identifies the importance of good venous access & correct timing of vesicant drug administration.

Takes measures to protect the health of patients, colleagues and self when administering cytotoxic drugs.

Demonstrates safe handling of cytotoxics which reduces the potential for spillage, airborne or skin contamination. Handles and changes intravenous sets in a manner, which reduces the potential for spillage, splashing, and airborne or skin contamination. Wears protective clothing. Changes bags away from patients. Washes hands.

Assessors should observe the student’s technique of wearing apron & gloves, doesn’t change chemo bag at eye level, change bag over the trolley on a flat surface with gauze and takes cytotoxic bin with them to the patient. Hand washing. Doesn’t re-use equipment, and can identify single use equipment.

Discusses the relevance of pre-treatment checking of patient surface area and drug dosages.

Recognises importance of working with current surface area in relation to drug dosage. Operates according to local policy in the checking of surface area and drug dosages. Recognises importance of dose reductions and checks for this appropriately.

Student has an awareness of the importance of calculating body surface area; height and weight are calculated to determine drug dosage. Dose reductions may be made by the doctor in the case of reduced or impaired renal function, bone marrow depression, liver impairment or toxicities.

Outlines normal blood values, discussing their relevance and demonstrates knowledge of appropriate interventional skills.

Interprets blood values of individuals and identifies when chemotherapy should be withheld. Initiates appropriate intervention.


Student has an awareness of the normal blood values. For example

white cell count, platelets, haemoglobin.

Student has an understanding of neutropenia and why patients are sometimes deferred a week, and why GCSF is administered.

Checks the drug prior to administration according to local and national policies and procedures.

Checks correct patient/drug/dose/time/route. Verifies treatment regimen according to local policy.

Follows (can describe) patient verification policy & administration of chemotherapy policy.

Discusses principles of practice when administering chemotherapy e.g.

- type of equipment used - sequencing of bolus drugs - patient positioning - methods used to achieve vasodilation - use of scalp coolers.

Distinguishes between timings of vesicant, irritant and non-irritant chemotherapy. Explains choice of environmental and intravenous equipment, patient positioning, and infusion fluid. Demonstrates awareness of environmental factors which could contra-indicate the appropriateness of chemotherapy delivery. Discusses use of aids to practice, such as scalp-coolers and methods to achieve vasodilatation.

Student has an understanding that vesicants are administered first after the anti-emetics, always checking venous return and a good flow rate of IV fluids. Ensure the patient is comfortable, arm supported, and repeatedly checking comfort, venous return and flow rate.

Scalp coolers used, with the aim to prevent alopecia with certain drugs. Demonstrate awareness of why scalp cooling is not offered to the haematology patient.

Demonstrate competence in the assessment of peripheral cannulae prior to chemotherapy delivery.

Demonstrates ability to assess for vein patency, to include checking: - patient pain level - length of time cannula in situ - absence of obvious signs of phlebitis


- venous return - a rapid drip rate on gravity.

To be deemed competent for IV chemotherapy bolus peripherally delivery the student should be proficient at cannulation.

Demonstrates proficiency in administering subcutaneous chemotherapy.

Chooses an appropriate site of administration. Aware of need to rotate injection site. Performs procedure safely. Monitors patient during administration for signs of adverse reactions/events and demonstrates ability to take appropriate action. Anticipates and plan interventions to minimise potential side effects. Document procedure. Initiates specific patient monitoring required.

Demonstrates proficiency in dispensing and administering oral chemotherapy.

Ensures patient toxicities are reviewed prior to dispensing oral chemotherapy. Undertakes appropriate prescription/ medication checks prior to dispensing chemotherapy. Educates patient on the use of oral chemotherapy and ensures they understand the scheduling involved. Educates patient on signs of adverse reactions/events and how to manage these from home. Plans interventions to minimise potential side effects. Documents procedure Ensures patient has a follow-up appointment and out of hours contact telephone number. Instigates appropriate community involvement/communication as needed.



Competency 5: Safe handling of cytotoxics

Discusses the potential hazards to health associated with cytotoxic drugs.

Names the three main routes of exposure. Understands potential consequences of exposures.

Inhalation, indigestion, absorption (skin contact). Cytotoxic drugs have carcinogenic, teratogenic, mutagenic properties.

Reflects on professional and local guidelines in relation to

- Safe handling of cytotoxic drugs. - Transporting and storing cytotoxics - Spillage of cytotoxic - Disposal of cytotoxic waste

Aware of relevant guidance. Acts in accordance with local policies and procedures.

- needlestick injury - administration chemotherapy - extravasation - cytotoxic spillage - anaphylaxis

Demonstrates preparation of equipment and the environment to reduce the risk of contamination / exposure.

Observed technique. Appropriate placement of cytotoxic bin, avoids spillage. Takes measures to assess risk and minimise exposure.

Assessor should observe the student’s technique of wearing appropriate safety equipment, changes bag over the trolley on a flat surface with gauze, takes cytotoxic bin with them to the patient.

Takes measures to protect the health of patients, colleagues and self when administering cytotoxic drugs.

Demonstrates safe handling of cytotoxics which reduces the potential for spillage, airborne or skin contamination. Handles and changes intravenous sets in a manner, which reduces the potential for spillage, splashing, and airborne or skin contamination. Wears protective clothing. Changes bags away from patients. Washes hands.


Assessors should observe the student’s technique of wearing apron & gloves, doesn’t change chemo bag at eye level, change bag over the trolley on a flat surface with gauze and takes cytotoxic bin with them to the patient. Hand washing. Doesn’t re-use equipment, and can identify single use equipment.

Takes measures to protect the health of patients, colleagues and self when disposing cytotoxic waste.

Disposes of unused drugs, used equipment and other cytotoxic waste in adherence with local policy. Ensures appropriate facilities for disposal of waste are available. Ensures waste is clearly labelled and packaged appropriately. Wears protective clothing. Washes hands. Adheres to local policies for cleaning reusable equipment.


Competency 6: Side Effects

Explain common and long-term side effects of chemotherapy drugs given within own area.

Recognition and management of common side and long term side effect of chemotherapy. Ensure actions have been taken to minimise potential effects of the treatment. Explain to the patient the most common potential side effects of their treatment.

Student can identify common short term effects such as bone marrow depression, nausea & vomiting, mucositis, alopecia. Late side effects include cardio toxicity, secondary malignancy and infertility.

Discusses side effects of other drugs administered in conjunction with chemotherapy in regimens used in their own area.

Recognition and management of side effects of drugs given with chemotherapy. Discuss common prophylactic drugs & known side effects.

e.g Granesetron - constipation, headaches. Demamethasone – increased appetite, peri-anal irritation if given too fast, weight gain, indigestion.

Discusses the assessment of side effects using UKONS Triage Tool (toxicity-grading tool) and use of appropriate interventions.

Interprets pre-treatment side effects and identifies/demonstrates appropriate intervention. Identifies when chemotherapy should be withheld or dose adjusted


Students are able to use toxicity scales when assessing chemotherapy patients for toxicities.


Competency 7: Adverse reactions/extravasation

Explain the causes/potential risk factors of extravasation.

Can describe the relationship of phlebitis to extravasation in detail for peripheral cannulation. Understands main causes of phlebitis. Details how to minimize phlebitis risk by appropriate selection of equipment and patient management.

Student should know that phlebitis causes extravasation. Phlebitis can be chemical, mechanical or infective.

To avoid mechanical extravasation – cannulate using the smallest device possible to achieve outcome, cannulate away from the joint, avoid ported cannula’s use a secure dressing and use a cannula that is shown to reduce phlebitis. To avoid infective phlebitis, an aseptic/non-touch technique, hand washing, skin preparation, dressings, and appropriate changing of cannula’s (3 days/72 hours). To avoid chemical phlebitis, use the smallest device possible, flush well during and after bolus IV delivery, consider dilution, speed given and route.

Recognises the signs/symptoms of an extravasation from a peripheral cannula and distinguishes this from other causes e.g. vein flare.

Discusses the key indications that would lead to a suspicion of extravasation. Can distinguish between extravasation and flare reaction.

Student should know the sign of a peripheral extravasation include burning, stinging, erythema and / or swelling at the site, lack of blood return from the cannula, reduced flow rate and pain.

Recognises the signs/symptoms of an extravasation from a central venous catheter.

Can identify main indicators of an extravasated line, to include shoulder and neck pain. Identifies appropriate interventional assessment strategies. Recognises the significances of fibrin sheath formation around CVADs. Instigates appropriate interventions.


Student should know the signs could include aching/discomfort in the chest wall. Aching/discomfort in the shoulder and neck (crucial). Never overlook these symptoms. Not to give chemotherapy agents into a CVAD that doesn’t bleed back without further investigation. Results of investigation should be documented in the patient’s notes. Investigations include chest x-ray & linogram. Fibrin sheath may predispose to extravasation.

States the immediate and follow up management of an extravasation from a peripheral cannula.

Identifies appropriate intervention when managing extravasation. Ensures extravasation equipment is available in the environment. Knows where to find policy/equipment. Identifies appropriate reporting/documentation systems. Recognises own responsibility in managing the event.

Student should know to stop administering drug immediately, inspect site. Try and remove as much drug as possible, draw around the extravasation area with a pen and refer to extravasation policy (act accordingly) and inform medics. Document in the patients notes and complete green card.

States the immediate and follow up management of an extravasation from a central venous catheter.

Identifies appropriate intervention when managing extravasation. Ensures extravasation equipment is available in the environment. Knows where to find policy/ equipment. Identifies appropriate reporting/ documentation systems. Recognises own responsibility in managing the event.

Student should know to stop administering drug, try and aspirate as much as possible from the line. Refer to medics and plastics. Document in the patient’s notes. Although the incidence of extravasation from central lines is lower than that from peripheral lines the severity of the injury maybe greater due to later detection of extravasation and possible leakage of larger volumes of fluid.



Competency 8: Adverse Reactions/anaphylaxis

Identifies cytotoxic drugs within own clinical area known to have a potential to cause hypersensitivity / anaphylactic reactions and discusses precautions required for their administration.

Describes common reactions to chemotherapy during / shortly after delivery. Identifies appropriate premedication and / or interventions required.

Student should have the knowledge that potentially patients can react to all chemotherapy. However, common drugs are Carboplatin, Docetaxol, Paclitaxol, which is why pre-medication is given, and reqular observations.

Recognising reaction to monoclonal antibodies and what the student should do.

Explains the procedures to be undertaken in the event of a hypersensitivity/anaphylactic reaction.

Discusses, prevention, recognition and management of hypersensitivity and anaphylaxis according to local policy.

Student should have the knowledge that anaphylaxis is a severe system allergic reaction which involves respiratory difficulty, oedema, hypotension, fainting collapse or loss of consciousness. Treatment adrenaline plus supportive treatment e.g. bronchodilators, fluids, oxygen.

Hypersensitivity – Hydrocortisone & Piriton IV.

Knows where the crash trolley is and the emergency number.


Competency 9 & 10: Care & maintenance of PICC/ Care & maintenance of Skin Tunnelled Catheter


Demonstrates competence in the care and management of PICCs. Demonstrates competence in the care and management of tunnelled catheters. Demonstrates competence in the care and management of an implantable port if appropriate in working environment. Demonstrates competence in the care and management of mid lines if appropriate in working environment.

Demonstrates knowledge of device. Demonstrates ability to obtain blood samples/flush/dress/remove sutures/secure device according to local policy. Recognises the need for closed system+ devices where appropriate (e.g. bionectors) and can discuss how often these should be replaced. Provides explanation/educates patient/carer. Documents procedure. Instigates appropriate community involvement/communication as needed.

Demonstrates competence in the assessment of central venous access prior to chemotherapy delivery.

Demonstrates ability to assess for catheter patency, to include checking: - catheter flushes easily and shows no signs of occlusion/resistance. - Patient comfort levels when catheter is flushes - Venous return - Drip rate on gravity.

The student should have knowledge of the Network CINS Policy


Competency 11: Can demonstrate effective holistic assessment of patients

Demonstrates competence in undertaking a comprehensive, systematic holistic assessment. An assessment record should capture: o All identified needs o Relevant discussion relating to identified

needs o Overall conclusions of the assessment and

the evidence behind them: conclusions should be agreed with the patient and any major difference of opinion recorded

o A summary record of the principal findings, and care plan agreed with the patient

Demonstrates knowledge of assessment tool Discusses local service providers, referral criteria and support services available locally The student should have reached an agreed level of competence in key aspects of the assessment process.

The student should have knowledge of the Network Key Worker & Holistic Needs Assessment Policy



Competency 12: Cancer related complications

Explains the common physical complications of cancer and associated management.

Describes signs and symptoms of MSCC and network pathway. Describes signs and symptoms of SVCO and treatment pathway Describes signs and symptoms of neutropenia and treatment pathway Describes signs and symptoms of tumour lysis and treatment pathway Demonstrate an awareness that chemotherapy can result in late effects Demonstrates knowledge of local acute oncology including role & contact points


5. Competency Assessment

Competency 1: Undertakes successful cannulation of patients via peripheral route

No Competency Comments Competent

1 Discusses and identifies the need for peripheral vein cannulation.

2 Demonstrates the precautions to take in regard to blood spillage

3 Describes the normal anatomy of the arm, including major arteries, veins and nerves.

Observed Practice under supervision Competent

4 Demonstrates assessment of the patient ensuring suitability for peripheral cannulation. Checks previous dose & toxicities.

5 Prepares patient, explains procedure and answers any questions & refers on appropriately.

6 Demonstrates cannulation of the patient using aseptic technique, with suitable size cannula in appropriate vein

7 Ensures cannula is patent and securely dressed

8 Demonstrates safe disposal of equipment

9 Complete all relevant documentation

10 Provides evidence of 10 successful cannulations and administration of chemotherapy


Competency 2: Undertake successful phlebotomy


1 Discussed and identifies the need for venepuncture

2 Demonstrates awareness of the precautions to take in regard to blood spillage

3 Describes the normal anatomy of the arm including major arteries, veins and nerves

4 Demonstrates holistic assessment of the patient ensuring suitability for venepuncture

5 Identifies and prepares patient. Explains procedure and answers any questions

6 Ensure blood requests are correctly written and match the correct patient. Blood samples labelled correctly

7 Is able to state the correct order in which samples should be taken

8 Obtains blood sample from an appropriate vein using aseptic technique

10 Completes all relevant documentation

Competency 3: Biology of cancer. Why do we give Chemotherapy?


1 Briefly explains the phases of the cell cycle

2 Briefly explains how chemotherapy works on the cell

3 Briefly describes the use of targeted therapies


4 Outlines common drug regimens found within own clinical area

5 Understands sequence of events, knows how often cycles are repeated

Competency 4: Routes of administration


1 Briefly discusses different administration routes.

2 Identifies the rationale for routes of administration

3 Identifies necessary procedures to be completed prior to the commencement of certain chemotherapy drug.

4 Demonstrates appropriate use of chemotherapy pumps

5 Achieves 10 successful non-vesicant chemo treatments (document on attached sheet)

6 Achieves 5 successful vesicant bolus chemo treatments (document on attached sheet) Vesicant assessment is at discretion of assessor based on student competence.

7 Demonstrates knowledge of oral chemotherapy agents and their regimens

8 Demonstrates safety measures when administering oral chemotherapy

9 Discusses/relates to Trust Policy.


Student Name:

Date Name of drug Non Vesicant/Vesicant Comments Assessor Print Name

Recommendations for further development:

Week 4

Week 8

Week 12

Competency 5: Safe Handling of cytotoxics


1 Discusses potential hazard


associated with cytotoxic drugs.

2 Reflects on professional and local guidelines - Safe handling of cytotoxic drugs - Transporting and storing - Spillage of cytotoxics - Disposal of equipment and

unused drugs - Protective equipment.

3 Demonstrates preparation of equipment and environment to reduce risk of contamination or exposure.

4 Demonstrates measures to protect the health of patients, colleagues and self when administering and disposing of cytotoxics.

5 Demonstrates measures to be taken to protect patients, colleagues and self when disposing of patient body waste or managing spillage.

Competency 6: Side Effects


1 Explains common side effect of cytotoxic drugs to include

- Bone marrow depression - Alopecia - Stomatitis/mucositis - Nausea and vomiting - Fatigue - Diarrhoea + constipation.

2 Explains common side effects of other common drugs administered as part of the chemotherapy regimen i.e. Steroids, atropine, piriton


3 Demonstrates knowledge of the safe management of the febrile neutropenic patient according to Trust Policy.

4 Discusses the causes of febrile neutropenia.

5 Demonstrates an awareness of the action to be taken when a patient presents with neutropenia.

6 Demonstrates knowledge of the UKONS Triage Tool

7 Demonstrates knowledge through role play in management of side-effects

Competency 6: Side Effects - Role Play Scenarios Scenario 1 Mr Brown is about to start oral chemotherapy as the chemotherapy nurse identify what drug he will be having and present a first chemotherapy talk of the recognised toxicities and how to take the tablets and what to do if he is unwell? Scenario 2 Mrs Smith is on the phone and feeling unwell, her temperature is 37.9 she is having chemotherapy, what would your assessment be and what information would you want to discover from Mrs Smith? Scenario 3 Mr Wilson is 3 days into a 14 day oral chemotherapy cycle and he has lost his tablets what should he do?

Competency 7: Adverse Reactions - extravasation


1 Demonstrates knowledge of the procedure for the management of


extravasation of cytotoxic drugs.

2 Identifies location of extravasation kit.

3 Identifies the location of the procedure/policy for individual drug extravasations procedures.

4 Demonstrates the importance of maintaining a safe environment for self and patient.

5 Demonstrates understanding of the importance of adverse incidences.

6 Demonstrates awareness of local and national requirements for cytotoxic adverse reactions.

Competency 8: Adverse Reactions - anaphylaxis


1 Describes what anaphylaxis is

2 Identifies patients at increased risk of anaphylaxis

3 Identifies drugs likely to cause anaphylaxis.

4 Identifies location of emergency equipment.

5 Describes action to be taken if a patient experiences an anaphylactic reaction.

6 Completes all necessary documentation.

Competency 9: Vascular Access Devices - care and maintenance of PICC


1 Demonstrates knowledge of PICC’s

2 Demonstrates understanding of the risks associated with the procedure

3 Explains associated complications of


PICC catheter i.e. - Thrombosis - Chemical and mechanical

phlebitis - Infection - Fractured catheter - Blocked catheter - Migrated catheter.

4 Competently flushes and redresses PICC line according CINS* protocol.

5 Demonstrates a knowledge of how to remove a PICC and performs this task competently

6 Completes all relevant documentation.

* CINS – Collaborative Intravenous Nursing Service group formed to provide expert central vascular access care for Cheshire and Merseyside.

Competency 10: Vascular Access Devices - care and maintenance of Skin Tunnelled Catheter


1 Demonstrates knowledge of skin tunneled catheters.

2 Demonstrates understanding of the risks associated with the procedure.

3 Has knowledge and understanding of associated complication

- Thrombosis - Chemical and mechanical

phlebitis - Infection - Fractured catheter - Blocked catheter - Migrated catheter.

4 Demonstrate how to flush and dress catheter

5 Discusses referral process for removal of skin tunnelled catheter.


6 Completes all relevant documentation.

Competency 11: Holistic Assessment


1 Demonstrates effective communication Skills

2 Ensures that all assessments are holistic, including: Background information Current physical health and

prognosis Social/occupational well-being Psychological and emotional

well-being Religion and/or spiritual well-

being Culture and lifestyle aspirations,

goals and priorities Risk and risk management The needs of families and

friends, including carer’s assessments.

Regularly review assessments to take account of changing needs, priorities and wishes, and ensure information about changes is properly communicated.

3 Discusses symptom management, maintaining comfort and well being Understands the range of

therapeutic options available, including drugs, hormone therapy, physical therapies, counselling or other psychological interventions,


complementary therapies, surgery, community or practical support

4 Demonstrate awareness and understanding of Advance Care Planning, and the times at which it would be appropriate

Competency 12: Cancer related complications


1 Describes signs and symptoms of MSCC and network pathway.

2 Describes signs and symptoms of SVCO and treatment pathway

3 Describes signs and symptoms of neutropenia and treatment pathway

4 Describes signs and symptoms of tumour lysis and treatment pathway

5 Demonstrate an awareness that chemotherapy can result in late effects

6 Demonstrates knoedge of local acute oncology including role & contact points


5.1 Declaration of Competency

Declaration of competency

This declaration of competence confirms ( ) has successfully completed the Cheshire and

Merseyside Strategic Clinical Networks training package and is competent in the administration of cytotoxic

chemotherapy.

Name of assessor:

Signature of assessor:

Date:


Appendix 1: Recommended further reading

Allwood M, Stanley A, & Wright P (eds) (2003) ‘The cytotoxic handbook.’ Rawcliffe Medical Press Ltd. 4rth

Ed.

Benner P (1984) ‘From novice to expert: excellence and power in clinical nursing practice.’ Addison-Wesley.

Burnard P (1990) ‘Learning human skills: an experiential guide for nurses.’ Butterworth-Heinemann. 2nd

Ed.

Burns S & Bulman C (eds) (2000) ‘Reflective practice in nursing: the growth of the professional practitioner.’ Blackwell. 2nd

Ed.

Carson D & Montgomery J (1989) ‘Nursing and the law.’ Macmillan.

Castledine G (1998) ‘Writing, documentation and communication for nurses.’ Quay Publishing.

Dougherty L (2006) ‘Central Venous Access Devices: Care & Management.’ Blackwell Publishing

Dougherty L & Lamb J (1997) ‘Intravenous theory in nursing practice.’ Churchill Livingstone.

Grundy M (2000) ‘Nursing in Haematological Oncology’ Baillere Tindall

Holmes S (1997) ‘Cancer chemotherapy: a guide to practice.’ Assett Books. 2nd

Ed.

Hull C & Redfern L (1996) ‘Profiles and portfolios: a guide for nurses and midwives.’ Macmillan.

Kohner N (1994) ‘Clinical supervision in practice.’ Kings Fund.

Pickston M (ed) (1999) ‘A pocketbook for safer IV therapy: drugs, giving sets & infusion pumps.’ Scritech Education.

Priestman T J (1989) Cancer chemotherapy: an introduction.’ Springer & Verlag. 3rd

Ed.

Professional Nurse & Teasdale K (1993) ‘Professional nurse personal professional profile.’ Mosby.

RCN (1998) ‘Clinical practice guidelines: the administration of cytotoxic chemotherapy recommendations.’

RCN (2003) ‘Standards for infusion therapy.’

Summerhayes M & Daniels S (2003) ‘Practical Chemotherapy.’ Radcliffe Medical Press


Appendix 2: Glossary of terms

A Accelerated

A stage of progressive chronic myelogenous leukaemia in which the number of immature, abnormal white blood cells in the bone marrow and blood is higher than in the "chronic" phase, but not as high as in the "blast" phase.

Acute Having a short and relatively severe course: not chronic.

Adenocarcinoma A malignant tumour that begins in the epithelial cells that line certain internal organs

Adhesion Tendency of two cells or surfaces to unite.

Adenoma A tumour that is not cancerous

Adjuvant Treatment after surgery. May be chemotherapy, radiation, or hormonal therapy. Or a combination of all three.

Adjuvant Therapy Cancer treatment that involves surgery followed by chemotherapy and/or radiation to decrease the risk of the cancer recurring.

Agranulocyte A type of white blood cell. Monocytes and lymphocytes are agranulocytes.

Alkylating Agents A diverse group of chemical compounds generating highly reactive electrophils which interact with nucleophilic groups such as amino, carboxyl, phosphate, or sulfhydryl, forming a covalent bond. Interferes with DNA replication functions. Blocks cell division by causing cross-linking of DNA stands and abnormal base pairing.

Alkaline phosphatase An enzyme produced by the liver or bone. Elevated levels in the blood often may indicate a liver or bone problem

Alopecia Loss of hair.

Alpha-fetoprotein A protein often found in abnormal amounts in the blood of patients with liver tumours, testicular cancer, and germ cell malignancies.

Anaemia Any condition in which the number of red blood cells per cubic millimetre, the amount of haemoglobin in 100 millilitres of blood, and the volume of packed red blood cells per 100 millilitres of blood are less than normal.

Analogues A drug that differs in minor ways in molecular structure from the parent compound. They are more potent or cause fewer side effects.

Anaphylaxis An acute allergic reaction, characterized by shortness of breath, rash, wheezing and a drop in blood pressure.

Anaplastic Cancerous cells that divide rapidly and bear little or no resemblance to normal cells.

Antibody A protein produced by the body, formed by the immune system which defends the body against bacteria, viruses, toxins (antigens) or tumours.


Anticoagulant A substance, usually a drug, which reduces the body’s ability to coagulate (clot). For example; heparin or urokinase.

Antiemetic A drug used to control nausea and vomiting.

Antigen Any substance that as a result of coming in contact with the body reacts to produce an immune response, resulting in the production of antibodies or other defensive reaction by white blood cells.

Antimetabolites

A compound related closely to normal essential metabolites, yet differs enough to interfere with metabolic pathways of actively dividing cells. Acts in the S phase of the cell cycle by blocking metabolic pathways or by replacing essential metabolites.

Ascites An accumulation of serous fluid in the peritoneal cavity.

Autologous A procedure in which bone marrow/or stem cells is removed from a patient and then is given back to the same patient following intensive treatment. The same patient is both donor and recipient.

B Basophil A type of white blood cell. Basophils are granulocytes. Basophils assist with phagocytosis in the immune system.

B-Cell (B-Lymphocyte) A lymphocyte, derived from the bone marrow that is responsible for the production of humoral antibodies

Benign Non-malignant; not life-threatening.

Biological therapy Using the body’s own immune system to fight cancer. Also known as immunotherapy, biotherapy, or biological response modifier therapy.

Biopsy Surgical removal of body tissue which will be used for identifying disease

Blast cell An immature form of a blood cell or a normal embryonic cell.

Blast phase A stage of advanced chronic myelogenous leukemia in which the number of immature, abnormal white blood cells in the bone marrow and blood is extremely high. Also called blast crisis.

Bolus Intravenous medication administered as a concentrated mass.

Bone Marrow The body's `factory' for three types of blood cells: leukocytes (white blood cells), which help fight infection; erythrocytes (red blood cells), which carry oxygen throughout the body; and thrombocytes (platelets), which cause blood clotting.

Bone Marrow Aspiration The removal and examination of bone marrow cells.

Bone Marrow Donor A person who donates healthy bone marrow to a patient who has had high-dose cancer treatment. The patient is given the donor's healthy marrow during a bone marrow transplant.

Bone Marrow Harvest A procedure to collect healthy bone marrow, which will be stored and used in a future bone marrow transplant.

Bone Marrow Transplant (BMT)

A procedure to replace a patient's diseased or treatment-damaged bone marrow with healthy marrow. The new marrow can be marrow that has been previously removed from the patient


and stored until needed (autologous transplant); or marrow that is donated either from a genetically matched relative or unrelated donor (allergenic transplant) or from the patient's genetically identical twin (syngenic transplant).

BRCA1 A gene that normally helps to restrain cell growth.

C Cachexia Malnutrition with general ill health.

CA27-29 Tumour marker often expressed in patients with breast cancer.

Cancer A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread through the bloodstream and lymphatic system to other parts of the body.

Carcinogen A substance that is known/or associated with developing cancer.

Carcinogenesis The process by which normal cells transform into cancer cells

Carcinoma A malignant tumour arisingfrom epithelial cells

Carcinoma-in-situ Cancer that is still within its site of origin and has not spread to other tissues

CEA A laboratory test to measure the level of carcinoembryonic antigen (CEA), a substance that is sometimes found in an increased amount in the blood of patients with certain cancers.

CA 125 A protein that can be found in the blood and is useful in detecting and evaluating ovarian cancer.

Cell cycle The discrete stages that a cell goes through from the time it is formed until it divides into two new cells.

Cell cycle (phase) non-specific agents

Chemotherapeutic agents most active during a particular phase of a cell cycle

Cell division The process by which cells reproduce (a single cell divides into two new daughter cells).

Cell membrane That part of the cell separating the cytoplasm from liquid environment surrounding the cell. Centrosome – cell centre: a zone of cytoplasm that contains one or two centrioles but is devoid of other organelles.

CEA A protein that can be found in the blood and is useful in detecting and evaluating colon cancer.

Chemosensitizers Drugs or chemicals that enhance the effects of anticancer drugs and improve their efficiency

Chemotherapy Treatment using drugs to kill cancer cells and shrink tumours. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream and can kill cancer cells throughout the body.

Combination chemotherapy Treatment in which two or more chemotherapy drugs are used to obtain more effective results.

Chromosome A linear strand of DNA and proteins in the nucleus of a cell. Chromosomes carry genes and function in the transmission of hereditary information.

Chronic Persisting over a long period of time: not acute

Clinical trials Studies that evaluate new drugs or new types of treatment.

Colony-stimulating factors Substances that stimulate the production of blood cells. Treatment with colony stimulating


factors (CSF) can help the blood-forming tissue recover from the effects of chemotherapy and radiation therapy. These include granulocyte colony-stimulating factors (G-CSF) and granulocyte-macrophage colony stimulating factors (GM-CSF).

Contact inhibition The growth and movement of a normal cell stops when it comes in contact with another cell.

Control group A group of patients who receive the standard medical treatment for their disease. The results of patients who have received experimental treatment are compared to those in the control group to identify effectiveness and reliability.

CT Scan (computer tomography scan)

A diagnostic test which uses x-rays and a computer to view organs and areas inside the body.

Cytogenetics

The study of chromosomes

Cytokine A protein produced and released by system cells to alter immune function by increasing the proliferation of various types of white blood cells.

Cytoplasm A clear, thick liquid located within the cell that contains the nucleus and other organelles and that performs most of the work necessary for maintaining the life of the cell; the protoplasmic material of the cell other than the nucleus

D Differentiation To develop a specialised shape, character, or function that differs from that of other cells or tissues; usually implies a loss of malignant nature.

DNA

The substance of heredity; a large molecule that carries the genetic information that cells need to replicate and to produce proteins. DNA is a double-stranded molecule held together by weak bonds between base pairs of nucleotides. The four nucleotides in DNA contain the bases: adenine (A), guanine (G), cytosine (C), and thymine (T). In nature, base pairs form only between A and T and between G and C; thus the base sequence of each single strand can be deduced from that of its partner.

DNA probe Any biochemical used to identify or isolate a gene, a gene product, or a protein.

DNA repair genes

Certain genes that are part of a DNA repair pathway; when altered, they permit mutations to pile up throughout the DNA.

DNA sequence

The relative order of base pairs, whether in a fragment of DNA, a gene, a chromosome, or an entire genome. See base sequence analysis.

Domain

A discrete portion of a protein with its own function. The combination of domains in a single protein determines its overall function.

E Ectoderm The outer layer of cells.

Endoderm The innermost layer of cells.


Ethics The study of fundamental principles that defines values and determines moral duties and obligation.

Eosinophil A type of white blood cell that protects against infection.

Enzyme A protein that facilitates a specific chemical reaction

Erythrocytes The haemoglobin-containing cell found in the blood of vertebrates, red blood cells

Extravasation Infiltration or leakage of medication into the tissue surrounding the cannulation site.

F Fascia A sheet of fibrous tissue that envelops the body beneath the skin. It also encloses muscles, or groups of muscles.

G Gene A hereditary unit that is located in a specific place on a chromosome. Genes determine physical characteristics, such as hair or eye colour. When genes are missing or damaged, cancer may occur.

Gene Therapy Using genes inserted into the patient's body or tumour to stimulate the immune system to fight cancer.

G-CSF - granulocyte colony stimulating factor

A medication used to increase the white blood cell count.

Grading A system for classifying cancer cells in terms of how malignant (cancerous) or aggressive they appear to be.

Granulocyte A mature granular leukocyte (neutrophils, eosinophils, and basophils).

H Haematopoiesis The process of blood development in the bone marrow.

Haematology The study and treatment of blood and blood-forming tissues.

Haemolytic Destructive to blood cells, resulting in liberation of haemoglobin from the red blood cells.

Histology The study of the structure and function of tissues.

Homeostasis The condition in which the external and internal environment of a cell remains relatively constant.

Hormone therapy Treatment that prevents certain cancer cells from getting the hormones they need to grow.

Hyperplasia An increase in the number of cells in a tissue or organ.

I Induction chemotherapy Chemotherapy usually with high doses of anticancer drugs (as cisplatin or methotrexate) in the initial treatment of advanced cancers in order to make subsequent treatment (as surgery or radiotherapy) more effective.

Infiltrating cancer Cancer that has spread beyond the layer of tissue in which it developed. Infiltrating cancer is also called infiltrating carcinoma or invasive breast cancer.


Imaging Procedures that produce pictures of areas inside the body.

Immunotherapy See Biological therapy.

Immune System The body's natural defence system which produces antibodies to fight against foreign substances such as bacteria, viruses, toxins, and cancers.

Immune response

A bodily response to an antigen that occurs when lymphocytes identify the antigenic molecule as foreign and induce the formation of antibodies and lymphocytes capable of reacting with it and rendering it harmless - called also immune reaction

Immunosuppression Suppressing the body's immune system and its ability to fight infections or disease. It may be deliberate (e.g., to prevent transplant rejection) or as an incidental side effect of chemotherapy or other treatments.

Immunology The study of the body's natural defence system.

Immunotherapy Treatment that uses the body's natural defences to fight cancer. Also called biological therapy.

Initiation The first step in turning a normal cell cancerous as by drugs, chemicals, or other agents.

Intercalation The process of drugs sliding between DNA bases to block RNA or DNA synthesis.

Interferon A substance that stimulates the growth of certain disease-fighting blood cells in the immune system, thus improving the body's natural response to disease. A type of biological response modifier.

Interleukin A substance used in biological therapy that stimulates the growth and activities of certain kinds of white blood cells.

Interleukin-2 A substance that stimulates the growth of certain disease fighting blood cells in the immune system, thus improving the body's natural response to disease. A type of biological response modifier. Also called IL-2

Interphase The period in the cell cycle when DNA is replicated in the nucleus; followed by mitosis.

Intraperitoneal chemotherapy Treatment in which anticancer drugs are put directly into the abdomen through a thin tube.

Intrathecal chemotherapy Treatment in which drugs are put directly into the thin space between the lining of the spinal cord and brain to treat or prevent cancer, pain or infection.

Intravenous Injected in a vein. Also called IV.

Intravesical Within the bladder.

Invasion As related to cancer, the spread of cancer cells into healthy tissue adjacent to the tumour

Invasive cancer Cancer that has spread beyond the layer of tissue in which it developed. Invasive breast cancer is also called infiltrating cancer or infiltrating carcinoma.

J

K


L Leukaemia A blood malignancy characterized by a greatly elevated level of circulating immature white blood cells.

Leukocytes Cells that help the body fight infections and other diseases. Also called white blood cells (WBCs).

Leucopoenia Any situation in which the total number of leukocytes in the circulating blood is less than normal, the lower limit of which is generally regarded as 5,000 per mm3

Lymph

An almost colourless fluid that travels through the lymphatic system and carries cells that help fight infection and disease.

Lymph nodes

Small, bean-shaped organs located along the channels of the lymphatic system. Bacteria or cancer cells that enter the lymphatic system may be found in the nodes. Also called lymph glands.

Lymphatic system

The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. This system also has channels that carry lymph.

Lymphocyte A variety of white blood cells arising in the reticular tissue of the lymph glands, involved in immune response; B- and T-cells are the two major subtypes.

M Malignant Cancerous; life threatening.

Mammogram Breast x-ray used to detect breast cancer

Marker

A gene with a known location on a chromosome and a clear-cut phenotype, used as a point of reference when mapping a new mutant.

Matched Unrelated Transplants (MUDs

Refers to bone marrow transplantation procedures in which the patient and the bone marrow are genetically matched but not family members.

Medical Oncology The study and treatment of cancers with chemicals, biological products or immunotherapy.

Megakaryocyte The bone marrow cell responsible for platelet production.

Metaphase A stage in mitosis or meiosis during which the chromosomes are aligned along the equatorial plane of the cell.

Metastasis The spread of cancer from one part of the body to another. Cells in the metastatic (secondary) tumour are like those in the original (primary) tumour.

Micrometastasis A metastasis too small to detect by conventional diagnostic methods.

Mitochondrial DNA The mitochondrial genome consists of a circular DNA duplex, with 5 to 10 copies per organelle

Mitosis

The process of nuclear division in cells that produces daughter cells that are genetically identical to each other and to the parent cell.


Molecule

A group of atoms arranged to interact in a particular way; one molecule of any substance is the smallest physical unit of that particular substance.

Monoclonal antibodies

Substances that can locate and bind to cancer cells wherever they are in the body. They can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to the tumour cells.

Monocyte A relatively large mononuclear leukocyte that normally constitutes 3% to 7% of the leukocytes in circulating blood; normally found in lymph nodes, spleen bone marrow, and loose connective tissue.

Mutagen A substance that alters DNA in a cell.

Myeloid Pertaining to, derived from, or resembling bone marrow

MRI Scan (magnetic resonance imaging scan)

A diagnostic test that uses magnetic fields to produce two or three dimensional images of organs inside the body.

Myelosuppression Suppression of the bone marrow. In cancer this can occur in patients treated with chemotherapy.

N Nadir The lowest point the blood count reaches after chemotherapy is administered.

Necrosis Cell death.

Neoadjuvant chemotherapy Chemotherapy administered prior to local control.

Neoplasm An abnormal mass of cells typically exhibiting progressive and uncontrolled growth; classified by the cell type from which they originate and their biologic behaviour.

Neutropenia The presence of abnormally small numbers of neutrophils in the circulating blood.

Neutrophil A mature white blood cell in the granulocyte series, formed by myelopoietic tissue of the bone marrow and released into the circulating blood.

Nucleus The control centres of the cell; usually located near the cell’s centre.

O Oncology The study and treatment of cancers.

Oncogenes

Genes that normally play a role in the growth of cells but, when over expressed or mutated, can foster the growth of cancer.

P Palliation The relief of symptoms, but not for cure.

Pancytopenia Low levels of all mature haematological cell components (white cells, red cells and platelets). In patients treated with chemotherapy pancytopenia may be the result of the toxic effects on the bone marrow.

Papavaviruses A group of viruses that are primarily oncogenic.

Peripheral stem cell support A method of replacing blood-forming cells destroyed by cancer treatment. Certain cells (stem cells) in the blood that are similar to those in bone marrow are removed from the patient's blood


before treatment. The cells are given back to the patient after treatment.

PET Scan A diagnostic test that uses a sophisticated camera and computer to produce images of how your body is functioning. PET scans show the difference between healthy and abnormally functioning tissues.

Platelet A little plate or plaque; specifically a blood platelet, an irregularly shaped disk containing granules in the central part and peripherally; clear protoplasm but no definite nucleus

Promotion The prolonged process of turning a precancerous cell into a cancer cell.

Protocol The outline or plan for the use of an experimental procedure or experimental treatment.

PSA (prostate specific antigen)

A protein which comes from the prostate gland. The PSA test, which measures the levels of prostate specific antigen in the blood, is one test for prostate cancer.

R Ribonucleic acid (RNA)

A chemical found in the nucleus and cytoplasm of cells; it plays an important role in protein synthesis and other chemical activities of the cell. The structure of RNA is similar to that of DNA. There are several classes of RNA molecules, including messenger RNA, transfer RNA, ribosomal RNA, and other small RNAs, each serving a different purpose.

Ribosomes Cell organelles concerned with protein synthesis within the cell.

Remission Complete or partial disappearance of a disease, a period during which manifestations of a disease are not evident.

S Sarcoma A type of cancer that starts in the bone or muscle.

Side effects

Problems that occur when treatment affects healthy cells. Common side effects of cancer treatment are fatigue, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

Sperm banking

Freezing sperm before cancer treatment for use in the future. This procedure can allow men to father children after loss of fertility.

Stage

The extent of a cancer, especially whether the disease has spread from the original site to other parts of the body.

Stem cell A cell with unlimited productive capacity; daughter cells may differentiate into other plasma cells.

Stomatitis Inflammation of the mucous membrane of the mouth.

Suppressor cell A ‘T’ lymphocyte that can inhibit antibody production by plasma cells.

T T-cell – (T-Lymphocyte) A lymphocyte altered by passage through the thymus, which becomes responsible for the phenomenon of cellular immunity.

Telephase The final stage of mitosis where migration of chromosomes to cells is complete.

Teratogen A substance causing mutations in a developing fetus.


Therapy The treatment of disease.

Thrombocytopenia A condition in which there is an abnormally small number of platelets in the circulating blood.

Thrombocytosis An increase in the number of platelets in the circulating blood.

Toxicity The quality of being poisonous

Tumour A mass of excess tissue.

Tumour markers

Substances found in abnormal amounts in the blood, in other body fluids, or in tumour tissue of some patients with certain types of cancer.

Tumour suppressor genes Genes that normally restrain cell growth but, when missing or inactivated by mutation, allow cells to grow uncontrolled.

U

V Virus A group of extremely small infectious particles.

Vein flare Erythematous or welt-like patches, accompanied by itching or burning along the vein, should not be confused with extravasation.

Vesicant A medication that has the potential to cause cellular destruction and damage and local necrosis upon leakage into the subcutaneous tissue.

Vinca alkaloids A compound that destroys spindle formation causing cessation of mitosis.

W White Blood Cells Cells which help fight infections; also called leukocytes. (Adapted from HYCCN with thanks)

Chemotherapy Training Programme V. 3.0 – Approved May 2014 of 48

Appendix 3: UKONS Triage Tool