Download Myeloma - London Cancer Alliance

Myeloma
Patient Name
Dear Patient Name
TREATMENT SUMMARY
You have now completed your initial treatment for cancer. This Treatment Summary provides a summary of
your diagnosis, treatment and on-going management plan. It includes information on the symptoms you should
be aware of, and who to contact. Your GP will also receive a copy of this summary.
Diagnosis:
Date of Diagnosis:
Myeloma
Summary of Treatment and relevant dates: (delete as necessary)
Intensive
Non-intensive
Other
Organ/Staging
ISS (Stage)
Performance Status (ECOG)
Local/Distant
Treatment Aim: (delete as necessary)
Curative
Non-curative
Include remission date
Name drugs
Radiotherapy intervention
Possible treatment toxicities and / or late effects:
Kyphosis due to previous bone damage
Renal toxicity due to disease/ treatment
Neuropathy due to disease or treatment
Cardiac failure
Interstitial lung disease
Tiredness
Impaired fertility/ early menopause
Secondary cancers
Osteonecrosis of the jaw (on bisphosphonates)
Psychological morbidity
Additional regime specific side effects/consequences
Advise entry onto primary care palliative or
supportive care register
Yes/No
Added to CMC
Yes / No
DS 1500 application completed
Yes/No
Prescription Charge exemption arranged
Yes/No
Alert Symptoms that require referral back to specialist team:
Contacts for re referrals or queries:
Increased creatinine
Increased bone pain and/or back pain
Increased calcium
Recurrent infections
Worsening tiredness/anaemia
Suspected metastatic spinal cord compression- contact team within 24 hours of
presentation- link to LCA AOS guidelines
In Hours: CNS
Out of hours:
Other service referrals made: (delete as nec)
District Nurse
Secondary Care Ongoing Management Plan: (tests, appointments etc)
Review in clinic every three to six months.
AHP
Social Worker
Dietitian
Clinical Nurse Specialist
Psychologist
Benefits/Advice Service
Palliative Care
Other
Required GP actions in addition to GP Cancer Care Review (e.g. ongoing medication, osteoporosis and cardiac screening)
Be alert to possibility of new symptoms as a consequence of cancer and its treatment
As per secondary effect checklist
No live vaccinations
(On-going) pain control
Flu vaccine annually
Pneumovacc as per national guidelines
Summary of information given to the patient about their cancer and future progress:
Treatment response
Planned follow up
Additional information including issues relating to lifestyle and support needs:
Works/Education
Travel
Exercise/Diet
Dental Care for people on bisphonates
MSCC alert card and information
Health and Wellbeing Event:
Completing Doctor:
Signature:
Date:
Supporting Documents that may help – Please delete this section before giving to the patient


Fatigue Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/122127/lca-hna-fatigue-prompt-sheet-january-2016.pdf)
Pain Prompt Tool (http://www.londoncanceralliance.nhs.uk/media/122133/lca-hna-pain-prompt-sheetjanuary-2016.pdf)
GP READ CODES FOR COMMON CANCERS (For GP Use only). Other codes available if required.
(Note: System codes are case sensitive so always ensure codes are transcribed exactly as below)
System 1
Diagnosis:
Lung Malignant Tumour
Carcinoma of Prostate
Malignant tumour of rectum
Bowel Intestine
Large Bowel
Female Malignant Neoplasia
Male Malignant Neoplasia
Histology/Staging/Grade:
Histology Abnormal
Tumour grade
Dukes/Gleason tumour stage
Recurrent tumour
Local Tumour Spread
Mets from 1°
Treatment
Palliative Radiotherapy
Curative Radiotherapy
Chemotherapy
Radiotherapy
Treatment Aim:
Curative procedure
Palliative procedure
Treatment toxicities/late effects:
Osteoporotic #
Osteoporosis
Infection
Ongoing Management Plan
Follow up arranged (<1yr)
Follow up arranged (>1yr)
No FU
Referral PRN
Referrals made to other services:
District Nurse
Social Worker
Nurse Specialist
SALT
Actions required by the GP
Tumour marker monitoring
PSA
Osteoporosis monitoring
Referral for specialist opinion
Advised to apply for free prescriptions
Cancer Care Review
Palliative Care Review
Medication:
New medication started by specialist
Medication changed by specialist
Advice to GP to start medication
Advice to GP to stop medication
Information to patient:
DS1500 form claim
Benefits counselling
Cancer information offered
Cancer diagnosis discussed
Aware of diagnosis
Unaware of prognosis
Carer aware of diagnosis
Miscellaneous:
On GSF palliative care framework
GP OOH service notified
Carers details
National Cancer Survivorship Initiative
December 2010
(5 digit
codes)
XaOKG
X78Y6
XE1vW
X78gK
X78gN
B34..
B35..
4K14.
X7A6m
XaOLF
XaOR3
X7818
XaFr.
5149.
XalpH
x71bL
Xa851
Xallm
XaiL3
Xa1TO
XaELC
Xa9ua
8H8..
XaL..
8HA1.
8HAZ.
XaBsn
XaBsr
XaAgq
XaBT6
Xalqg
Xalqh
XalSd
Xalst
9D05
Xalyc
XalG1
XEOhn
8B316
XaKbF
XaJC2
All other systems
Version 3 five byte
codes
(October 2010
release)
Diagnosis
Malignant neoplasm of bronchus or lung
Malignant neoplasm of prostate
Malignant neoplasm of Rectum
Malignant neoplasm of Colon
Malignant neoplasm of female breast
Malignant neoplasm of male breast
B22z.
B46..
B141.
B13..
B34..
B35..
Histology/Staging/Grade:
Histology Abnormal
Tumour staging
Gleason grading of prostate Ca
Recurrence of tumour
4K14.
4M…
4M0..
4M6..
Metastatic NOS
Treatment
Radiotherapy tumour palliation
Radiotherapy
Chemotherapy
BB13.
5149.
7M371
8BAD.
Treatment Aim:
Curative treatment
Palliative treatment
8BJ0.
8BJ1.
At risk of osteoporosis
Osteoporosis
1409.
N330.
Ongoing Management Plan
Follow up arranged
8H8..
No follow up arranged
8HA..
Referrals made to other services:
Refer to District Nurse
Refer to Social Worker
8H72.
8H75.
Actions required by the GP
Tumour marker monitoring
PSA
Osteoporosis monitoring
8A9..
43Z2.
66a..
Entitled to free prescription
Cancer Care Review
Palliative Care Plan Review
Medication:
Medication given
Medication changed
6616.
8BAV.
8CM3.
8BC2.
8B316
Information to patient:
DS1500 completed
Benefits counselling
Cancer information offered
Cancer diagnosis discussed
9EB5.
6743.
677H.
8CL0.
XaJv2
Xaltp
Miscellaneous:
On GSF Palliative Care Framework
GP OOH service notified
8CM1.
9e0..
9180.
Carer details
9180.
XaCDx
6743.
XalmL
XalpL
XaQly
XaVzE
XaVzA