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5 minute briefing

Blood cancers, chemotherapy and the risks of neutropenia

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An expert nurse advises on safe, effective care and when to contact a specialist nurse

5 key points

  1. All patients on chemotherapy need to be assessed for neutropenia or their risk of becoming neutropenic. Signs of  neutropenic sepsis are a temperature of  ≥38oC or clinical evidence of infection
  2. Pyrexia should never be ignored in neutropenia even if the patient appears well
  3. If infection is suspected, the patient must be clinically assessed and start intravenous antibiotics within one hour
  4. Use reverse barrier nursing to reduce risk of introducing infection when caring for neutropenic patients. Hand washing and plastic aprons are recommended, while gloves and masks are not usually appropriate (check trust guidelines)
  5. If a patient is neutropenic or likely to become neutropenic, four hourly observations are essential day and night

Haematological malignancies are a diverse set of conditions affecting the blood, bone marrow and lymphatic system and make up approximately 7% of all cancers in the UK. These include multiple myeloma, lymphomas and leukaemias.

They may be aggressive diseases which require treatment with intensive chemotherapy and can often be cured or less aggressive, low grade conditions, which may not need treatment at diagnosis.

Haematology patients are often elderly, with multiple co-morbidities, and can present in a range of healthcare settings including orthopaedics, renal and cardiac care.

Although surgery (splenectomy) and radiotherapy have their place in treating haematological malignancies, these diseases are rarely confined to a single site and usually require systemic chemotherapy treatment. This can be given orally as an outpatient or intravenously as a day case, while the most intensive, inpatient treatments are only given in specialist units.

Chemotherapy side effects vary depending on the specific drugs used in each protocol, ranging from red or blue-coloured urine to neuropathy and constipation. The effects most commonly associated with chemotherapy are nausea, vomiting and alopecia.

Suppression of blood counts – in particular neutropenia, which brings a risk of life-threatening sepsis – is a risk with all chemotherapy and the biggest concern for this group of patients. Neutropenia is typically defined as a neutrophil count ≤0.5x109/l. and usually occurs at around 7-10 days after chemotherapy.

Clinical nurse specialists meet patients at the time of diagnosis and act as their point of contact with the haematology team. They provide the patient with information on risks and concerns associated with their diagnosis and treatment and on what to do if they are unwell.

Graeme Butters is Macmillan clinical nurse specialist, haematological malignancies, North Bristol NHS Trust.

 

When to contact the nurse specialist

  • If a patient requires admission to a hospital even if the reason for admission is not directly linked to their haematology problem
  • If you are unfamiliar with a diagnosis or treatment and need advice on how to care for a patient
  • If you have concerns about a patient’s ability to manage treatment or side effects at home. Some oral chemotherapy regimes are complicated and can be difficult to manage. These drugs often cannot be dispensed in dosing aids. Elderly, isolated or very anxious patients can need additional support
  • If you require advice or assistance in the management of side effects or are unsure whether a problem is due to disease or to treatment
  • If you believe that the patient or their family need extra support or information, for example a change in condition or ongoing issues over coming to terms with a diagnosis
  • If you need advice and support regarding clinical issues, such as administration of chemotherapy, monoclonal antibodies and other anti-cancer agents, care of central venous access devices, specialised tests and investigations

Guidance and resources

The following websites provide an introduction and accessible resources on haematological malignancies and treatments.

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Readers' comments (1)

  • Gordon McGhee

    As a haematology nurse myself, I think this is one of the finest clearly put together "most important issues" lists that I have seen. Well done Graeme.
    Many areas like my own do not have a CNS in haematology and if that is your situation then contact your local Haematology or Day Unit to let them know of the admission you have received. They will I'm sure be very willing to give advice/input/guidance/onward referal etc if you require it. Even if you don't need help, DO LET THEM KNOW of the admission.
    For those interested to look further into the risks of neutropenic sepsis, there is an excellent video that can be viewed at www.cancernursing.org that Macmillan Cancer Support helped to fund.

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