Download Sick Cancer Patients - Peter Mac Education Portal

Dr Kortnye Smith
Medical Oncology Fellow
Medical Management
(+management of sick cancer patient)
Introduction to Peter Mac
Peter Mac Structure
-
Tumour Streams: Specialty specific
- Outpatients, MDM, Consults
• Includes Surgeons/Med Onc/Rad Onc
/Haem/Physicians/Nurse Coordinators/ Palliative
Care/Radiologist/Pathologist/Radiation
Therapists/Other specialists/AYA/ Psych/ Pharmacists
Inpatient Units
Inpatient Units
- Haematology
- Medical oncology
- Surgical Oncology
No bed card for:
-
Palliative care
-
General medicine (admitted under home team)
-
Radiation Oncology (admitted under Medical or Surgical
Oncology depending on cause for admission)
PMCC Specific Consulting Units
- Palliative care
- General Medicine
- Respiratory Medicine
- Cardiology
- Endocrinology
-
Acute Pain
Psychiatry
Familial Cancer
Adolescent and Young Adult
Acute Assessment Unit
- Higher Acuity Nursing
- General Medicine and HDU Assistance
- What its used for:
- New direct to hospital admissions (not all)
- Admissions from ED (particularly outside precinct) that
need rapid assessment on the ward
- Short term overnight admissions (Chemo-reaction in
CDU/Transfusion etc.)
- Higher nursing requirements
- Not a HDU
- Additional Support Provided by RMH ICU
Medical Day Unit
What is it for:
- Short treatments:
- transfusions, drug education (i.e. enoxaparin)
- Rapid Clinical Assessments of Outpatients
- Observation
- ? Able to be discharged ? Do they need admission
Patients in the RMH
- Most units will have patients in Royal Melbourne
-
Haem: transplant patients
Med Onc: overflow patients
Intensive Care Unit
Emergency
- Important
- Nurses need to be able to contact you
- Make sure you know who the after hours RMO at RMH is
covering your patients- hand over as required
- Switch can be challenging, especially at night- try to give
direct numbers
- Night RMO at PMCC can’t leave the building
Useful resources in the Hospital
Person:
- Registrars and Fellows
- Including other specialties
- Nurse Co-ordinators (via tumour stream)
- Nursing staff – Ward, AAA, CDU, MDU, Apheresis
- Diagnostic imaging – Access Coordinator
- Patient Service Manager
- Pharmacists, Drug Information
After Hours – Limitations
- Palliative Care:
- has 24 HOUR on call service, call early if concerned
- Radiology:
- Standard in-hours service only- nil standard on weekends
- Will come in for all medically required scans
- (discussion with radiology a/hours and at weekends)
- Pathology:
- Need to call for urgent overnight results (ie. LP)
- Bloods standard
- Limited:
- Security Assistance
- Psychiatric resources
- Interventional radiology
Clinical Viewer
Clinical Viewer: Good thing
Clinical Viewer: More Good things
Oncology Terminology: Medical Therapy
-
Chemotherapy
- Neo-adjuvant / Adjuvant
- Palliative– 1st / 2nd /3rd line treatment
- Maintenance chemo
- Concurrent / sequential
-
Chemotherapy Cycle
- C1D1, C1D8, C2D1
• Oncologists and Hematologists are pedantic, they always want this
detail
• Important to know days since last chemotherapy cycle.
Oncology Terminology:
Radiation + Surgical
-
Radiation
- Curative
- Palliative
- Concurrent
-
Surgery
- Curative
- De-bulking
- Palliative
Unit Admissions
-
Include
- Medical Treatment
• Curative or palliative intent
• Date of diagnosis
• Treating doctor
• Previous treatment
– Chemo, ? any radiotherapy (to where), surgery
• Cycle
- ECOG status
- Resuscitation status
• Check ACP (write ACP)
Oncology Medications
• Categories
-
Chemotherapy
Hormonal therapy
Immune therapy
Targeted agents
• Each have specific side effects
• Often given in combination
- E.g. FOLFOX, FEC-D, R-CHOP
YOU CAN’T LEARN THEM ALL, LOOK THEM UP (eVIQ)
Common After Hours Calls
- Fever – line (Hickman/PICC/Portacath)
- Pain
- Bone, muscular, neuropathic, other
-
Nausea and vomiting
Shortness of breath
Arrhythmia
General decline, Falls
Oncology emergencies
Oncology Medications: Precautions
BEWARE OF:
- Lots of drug-drug interactions
- Restrictions of drugs
- Suppression of Immune System
- Clinical Trials
- Sarcoma Chemotherapy
- Methotrexate: Antibiotics (including penicillins)
- Immunotherapy
- DO NOT GIVE STERIODS without checking first
- Clinical Trials
- Lots of contra-indicated drugs
Oncology Emergencies
- Febrile neutropenia (neutrophils <1.0)
- Usually 7-10 days post treatment
- See protocol (+ talk later today)
- Cord compression
- urgent MRI, steroids, neurosurgery, RT
- SVC obstruction
- steroids, RTx, interventional radiology
- Pulmonary embolus
- Pain crisis
Oncology Emergencies - 2
- Tumour lysis syndrome
- Hyperkalaemia, hyperphosphatemia, hyperuricemia,
hypocalcaemia
- Hyperhydration, urinary alkalization, allopurinol
- Hypercalcaemia (hydration, diuretics,
bisphosphonates, calcitonin, steroids)
- Ca(corrected) = Ca(measured) + (40-Alb) x 0.02
- Hyponatraemia - SIADH (fluid restrict,
demeclocycline, hypertonic saline)
Oncology Emergencies 3
- Bowel obstruction
- Immune phenomena
- Colitis
- Endocrinopathy
- Skin toxicity
- Extravasation
Useful Online resources
- Peter Mac INTRANET
- GUIDELINES
- eviQ - www.eviq.org.au
- www.cancer.gov
- UptoDate
- Therapeutic Guidelines