Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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 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 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