Download Hormone Deprivation Therapy

Prostate - Hormone Deprivation Therapy
Patient Name
Patient Address
Patient Post Code
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:
Organ/Staging
Prostate Cancer
Local/Distant
Summary of Treatment and relevant dates:
Treatment Aim: You are being treated with
medication to lower or block your testosterone
with the intention to control your prostate cancer.
Possible treatment toxicities and / or late effects:

Hot flushes

Bone density changes (osteoporosis)

Mood changes

Loss of body hair

Breast swelling and tenderness

Weight gain

Fatigue

Loss of sex drive and difficulty in achieving an erection

High blood sugar

Worsening of diabetes

Change in cholesterol levels

Psychological issues
Advise entry onto primary care palliative or
supportive care register
Alert Symptoms that require referral back to specialist team:
Contacts for re referrals or queries:
Yes / No
DS 1500 application completed
Yes/No
Prescription Charge exemption arranged
Yes/No
In Hours:
In relation to the prostate cancer:
 Difficulty in passing urine/ worsening urinary symptoms
Out of hours:
www.guysandstthomas.nhs.uk
patient name | date of birth | hospital number



Blood in your urine (haematuria)
Swelling in legs
Bone pain
Other symptoms to seek advice about:
 Feeling breathless
 Constantly feeling tired
 Unintended weight loss (more than 3kg)
 Loss of appetite
 Pain on passing urine (urine infection/cystitis)
 Problems controlling your bowel or bladder
Other service referrals made: (delete as nec)
District Nurse
AHP
Social Worker
Dietitian
Clinical Nurse Specialist
Psychologist
Benefits/Advice Service
Other
Seek urgent advice (A&E) if you experience
 Pulsating chest pain
 Signs of malignant spinal cord compression (MSCC)
 Back or neck pain which is getting worse
 Pain in your chest or abdomen that can radiates towards your
back, buttocks or legs
 Pain that moves down your arms and legs
 Weakness in your arms and legs
 Feeling unsteady on your feet, difficulty walking or your legs
giving way
 Numbness or pins and needles that doesn’t go away
 Problems controlling your bowels
Secondary Care Ongoing Management Plan: (tests, appointments etc)
You are on one of the following medications as part of your treatment
Prostap (injection) 11.25mg – every 12 weeks
Zoladex (injection) 10.8mg – every 12 weeks
Decapeptyl (injection) 11.25mg – every 12 weeks
Bicalutamide (tablet) 50mg/150mg - daily
Please continue on this medication until advised otherwise.
You may require a combination therapy if erectile dysfunction occurs:
PDE5 inhibitor (tablet) and daily vacuum device therapy (10 minutes everyday).
You will need to order your vacuum device through your GP - order code XX-50
PIP code 289-0713 – discuss with your consultant or nurse specialist at your
next appointment.
If you have tried PDE5 inhibitors with no effect you may wish to try penile
injections or urethral pellets/gel under the guidance of your GP or the hospital
andrology team.

Your outpatient appointments while you are under our care will be
every 2-6 months.

Always have a PSA done at least one week prior to your
outpatient appointment – if you do not have your PSA done at
Guys or St. Thomas’ please contact your GP to organise your
PSA and bring the results with you to your appointment.

Depending on your symptoms and response to treatment you may be
discharge back to the care of your GP if your condition is stable
Required GP actions in addition to GP Cancer Care Review (e.g. ongoing medication, osteoporosis and cardiac screening)
Summary of information given to the patient about their cancer and future progress:
Additional information including issues relating to lifestyle and support needs:
Contact your GP or practice nurse
Name | Date of birth | Hospital Number
PRIVATE AND CONFIDENTIAL
cc.
Patient GP Name
Patient GP Address
Patient GP Post Code
Supporting Documents that may help – Please delete this section before giving to the patient




Sexual Consequences for Men Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/118596/lca-hna-male-sexual-consequencesjanuary-2016.pdf)
Fatigue Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/122127/lca-hna-fatigue-prompt-sheetjanuary-2016.pdf)
Pain Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/122133/lca-hna-pain-prompt-sheet-january2016.pdf)
Weight Gain Prompt Tool
(http://www.londoncanceralliance.nhs.uk/media/118608/lca-hna-weight-gain-prompt-sheetjanuary-2016-v3.pdf)
Name | Date of birth | Hospital Number
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
(5 digit
codes)
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
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X78gK
X78gN
B34..
B35..
4K14.
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5149.
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8B316
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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
Carers details
All other systems
National Cancer Survivorship Initiative
December 2010
Name | Date of birth | Hospital Number