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How will I receive my SACT treatment?

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Treatment

You may have your treatment given to you:

Intravenously

This means the treatment will be given into a vein in your hand or arm. Different devices may be used:

A cannula

A cannula (thin tube) will be inserted into the back of your hand or arm into a vein.

The cannula will remain in place for the length of your day-case treatment. It will be removed before you go home.

If you are having your treatment over 24 hours or more and therefore staying in Lilleybrook or Rendcomb ward, the cannula can stay in place for a few days.

Your treatment can be given as a drip, through the cannula, into your vein. Or, your treatment can be slowly injected through the cannula and into your vein.

For more information about intravenous cannulas here.

A longer-term line/central line

Alternatively, you may have a longer-term line put into your upper arm or chest. There are 3 different types:

  1. Peripherally Inserted Central Catheter (PICC)
  2. Central line (tunnelled)
  3. Implantable port

Your treatment can be given as a drip, through one of these lines, into your vein. Or, your treatment can be slowly injected through the line and into your vein.

Community nurses/district nurses can look after these lines when you are at home. Please contact them directly, via your GP’s practice, to arrange this.

Oncology patients – can book for line blood tests and weekly dressing changes at the Nurse Led Clinic via the Oncology Booking Office:

Tel: 0300 422 3366 - Monday to Friday, 08:00am to 4:00pm

Haematology patients – can book for line blood tests and weekly dressing changes at the Edward Jenner Unit.

Tel: 0300 422 5255 - Monday to Friday, 08:00am to 4:00pm

Longer-term and central lines can stay in place for weeks, months or years.

For more information about the different types of central line, take a look at the Macmillan links below:

PICC

Central line (tunnelled)

Implantable port

or our Patient information leaflet.

Ambulatory SACT/Folfuser

Some intravenous treatment is given continuously over 24 hours or more via a pump. This pump is connected to a PICC, central line or port. The pump will be attached by the nurses in the hospital and your community/district nurse will need to disconnect it, 24 hours or more later, when you are at home. The SACT-trained nurses will complete the first referral to your community/district nurse for you, before you go home.

Risk of an extravasation injury

When treatment is given intravenously, it may feel cold but should be painless. An injury may happen if the drugs leak from the intended vein into the surrounding tissues under your skin. This is called an extravasation. The SACT-trained nurses do everything possible to prevent this from happening.

Signs and symptoms of extravasation include:

  • Pain
  • Burning
  • Stinging
  • Swelling

If you experience any of these signs and symptoms listed above in your arm/hand where the cannula goes, please let the nurses know immediately. You will then be given the necessary emergency treatment. An extravasation can also happen in your chest if you have a longer-term line.

You can help to prevent extravasation by:

  • Keeping warm and well hydrated while having your treatment
  • Be careful when you move not to pull at a drip connected to your cannula or central line.

If extravasation were to happen to you, you would have extra follow-up appointments to monitor the area. How often and for how long these appointments continue will depend on the signs and symptoms it causes.

Signs and symptoms of extravasation include:

If you experience any of these signs and symptoms listed above in your arm/hand where the cannula goes, please let the nurses know immediately. You will then be given the necessary emergency treatment. An extravasation can also happen in your chest if you have a longer-term line.

You can help to prevent extravasation by:

If extravasation were to happen to you, you would have extra follow-up appointments to monitor the area. How often and for how long these appointments continue will depend on the signs and symptoms it causes.

Injection

You may have your treatment as an injection into your muscle or the tissue under your skin. Some injections are given quickly and some are given over several minutes.

Oral tablets

You may have your treatment as oral tablets.

For more information about how SACT can be given, please visit Chemocare

Pharmacy

Each SACT prescription is checked by a member of the Cancer Services Pharmacy team. The pharmacy team consists of pharmacists, technicians and assistants.

If you're having treatment in either of the outpatient departments (Avening Ward or in the Edward Jenner Unit), your medicines will usually be sent directly there.

Prescriptions for intravenous SACT are sent to a manufacturing unit to be made.

Prescriptions for oral SACT are sent to a dispensing pharmacy. You may need to collect medicines from one of our pharmacies. Gloucestershire Royal Hospital have one pharmacy department. Cheltenham General Hospital has two pharmacy departments; the main dispensary in the West Block area, and the oncology dispensary based in Oncology Outpatients in the Oncology Centre. You will be told where to collect your medicines from, when the prescription is completed.

Pharmacy opening times:

  • CGH Oncology dispensary: Monday to Friday, 8:30am to -5:00pm
  • CGH main dispensary (West Block): Monday to Friday, 9:00am to 5:30pm, Saturday 10:00am to 1:00pm
  • GRH Pharmacy: Monday to Friday, 9:00am to 5:30pm

All pharmacies are closed to outpatients on Sundays and bank holidays.

Oral treatment consultation
Before you start taking an oral cancer treatment, you will have a consultation with one of the pharmacy team. During this consultation, they will discuss with you:

  • What your medicine is called and what it is used for
  • What support medications you may need to take alongside it
  • How and when to take your medicines
  • Possible side effects and how to manage them
  • Information about the Acute Haematology Oncology Unit, the FOCUS Information Centre and other support services such as Maggie’s Centre.
  • Other medicines you take at home and their effect, if any, on your cancer treatment
  • Information about the “Homecare” service, if applicable

Homecare

Some medicines can be delivered to your home by Homecare, this is a home delivery service. If you are eligible for Homecare, you will receive a small supply at first, and you will then receive a phone call from one of our Homecare companies to arrange delivery of a further and ongoing supply. At your next clinic appointment, you will have a “buffer” supply at home to prevent you from running out of tablets, while awaiting your next delivery. This will be explained in detail during your pharmacy consultation, and a consent form for your medicines will be completed by a member of the pharmacy team.

Supportive medications

It may be recommended for you to have some extra medications to help you through your treatment or to prevent side effects.

These medications include:

Anti-sickness drugs

Some SACT is known to cause sickness. Anti-sickness medication may be given to you before your treatment and you may have a supply of anti-sickness drugs to take home.

Steroids

Steroids can be used for several reasons. They are a very effective anti-sickness medication and, can help decrease inflammation and swelling, and boost appetite and energy levels.

Bisphosphonates

These drugs help to strengthen bones and reduce the risk of bone fractures. They are also used to reduce the levels of calcium in the blood, if needed.

It is important to have a dental check and any work done before starting these drugs.

If you have any dental problems during your treatment, it is important to report this to your team. Your treatment may need to be interrupted to allow for dental treatment to be done.

For more information about bisphosphonates, please visit: Macmillan and Cancer Research

Blood transfusions

Some SACT can cause the levels of blood cells to reduce. Three blood cells may be affected:

  1. Red Blood Cells carry haemoglobin in the blood. Haemoglobin carries oxygen around the body. Anaemia is the name given when the level of haemoglobin is low. To bring the level back up, a blood transfusion of RBCs can be given intravenously (through a drip). Depending on the type of cancer and the treatment you have, you may be at risk of transfusion-associated graft-versus-host Disease (TA-GvHD). If so, you will need to have irradiated blood.
  2. White Blood Cells make up the immune system. If these are low, the body is more prone to infections. Low levels of WBCs can be increased with an injection called Granulocyte -Colony Stimulating Factor (GCSF).
  3. Platelets prevent and treat bleeding and bruising. To increase a low level of platelets, you may need a platelet transfusion.

If you would prefer not to receive any blood products, please let the team know in advance of your treatment starting.

Electrolyte replacement

Electrolytes are naturally occurring nutrients in the body, which need to be kept within a certain range. For example, magnesium and potassium. Your treatment may affect the levels of electrolytes. Your blood tests will monitor the levels and if necessary, you may be given a replacement of those electrolytes intravenously.

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