Systematic anti-cancer treatment (SACT)

Information for patients receiving systematic anti-cancer treatment (SACT).

What is SACT?

Systemic anti-cancer therapy (SACT) refers to all medications used in the treatment of cancer, from traditional chemotherapy to newer targeted therapies, immunotherapies, and antibodies. They are most commonly given by:

Injection under the skin.
Drip into a vein.
Tablets to be swallowed.
A combination of injections, drips, and tablets.

Not all of these treatments are chemotherapy, however you may still hear them referred to as this and some of our services may have chemotherapy in their names.

What to expect?

If your treatment includes drips or injections, you will attend the Chemotherapy Suite in Gate 5 of the Brunel building at Southmead Hospital.
If you are only having tablets, you will be seen in the Haematology outpatients clinic by a doctor, pharmacists, or Clinical Nurse Specialist (CNS). You will be given enough medication to last until your next clinic appointment.
- Your first cycle of tablet treatment will be given to you in the Chemotherapy Suite by the specialist nurse. Here you will have the opportunity to discuss your treatment and any questions you have about taking it.

If you find you have less than a week’s supply of medication and do not have an appointment before you are due to run out please call the Haematology CNS team on 07545 21893.

What do I need to bring with me to the Chemotherapy Suite?

Drinks and snacks are provided throughout the day and a lunchtime sandwich, but you can bring your own refreshments if you prefer.
Something to keep you occupied like a newspaper or book. Wi-fi is available and you can bring your own laptop. We have portable DVD players and a selection of DVDs to use in the department.
Some patients like to have a family member or friend with them during their treatment; this is entirely up to you.

How is it given?

Depending on what treatment you have, drips may be given through a cannula in the back of your hand or you may be advised to have a PICC (peripherally inserted central catheter) placed in your arm. This is a thin tube which stays in place for the duration of your treatment. This can be used to give medication and take blood tests.

Some treatments are given by sub-cutaneous (under the skin) injections.

Pre-assessment

Before starting each cycle of treatment, you will be seen by a doctor or senior nurse. You will also be asked to give a blood sample and have your blood pressure and temperature checked. This is a good opportunity to discuss any problems or side-effects you are concerned about.

The pre-assessment will help to decide whether you are fit enough to start the next cycle and whether any adjustments are needed.

Will it hurt?

Your treatment should not be painful. If you are feeling pain let a member of staff know immediately.

Side-effects

Side effects vary depending on the type of treatment you receive. You will be given specific information about the side effects you might experience.

Infection (sepsis)

Your disease and the treatment can make you more vulnerable to infection. Neutrophils are white blood cells that fight off infections and if you don’t have enough of them then you are much more vulnerable to catching infections and becoming unwell. Your neutrophil count is a good indicator of how vulnerable you are.

A normal neutrophil count is between 1.5 and 8.0 x 10⁹/L. A neutrophil count that is below 1.0 x 10⁹/L is particularly dangerous. If you have an infection (we call this neutropenia).

Usually, the neutrophil count drops about 7-10 days after having chemotherapy. It is safe to be at home with a low count as long as you do not have any symptoms of infection, but it is a good idea to be extra careful, avoiding people with coughs, colds and infections as well as large gatherings of people. For example, the theatre, supermarkets, and restaurants for the duration of your treatment.

Handwashing is an important infection prevention measure, before and after going to the bathroom, handling food or rubbish. Before eating is probably the most important thing you can do to avoid picking up infections.

We will take extra precautions if you are in hospital and if your count is less than 1.0 x 10⁹/L.

Neutropenic sepsis means that you have an infection when your white blood cells are too low. This is a life-threatening emergency. Call for help immediately if you have recently had treatment or if you have been told that your condition puts you at risk and you become unwell with any of the following symptoms:

Temperature – Above 37.5°C or below 36°C.
Uncontrollable shivering/shaking (rigor).
Other signs of infection for example sore throat, cough, diarrhoea or vomiting that last for more than 24 hours, pain, burning or difficulty passing urine.
Pain, swelling, or redness at the site of your PICC line, if you have one.
Suddenly feeling unwell, even with a normal temperature.

Use the numbers on your Chemo Alert card (also on the back of this leaflet to speak to a nurse straight away.

Depending on the reason for you calling, you may be asked to contact your GP or come to a specific department in the hospital.

If you cannot get hold of us on the numbers on your chemo alert card and you think you have an infection, go to the nearest A&E. (You may need to phone 999 for an ambulance if you don’t have transport and feel too unwell to drive).

Please do not attempt to come to the Haematology Department or Chemotherapy Suite without an appointment as this may lead to a delay in getting the attention you need.
If you are admitted to hospital with a possible infection, you need to receive an intravenous dose of antibiotics within one hour of arriving. Please show your Chemo Alert card to staff and make sure they are aware of this.

Nausea and vomiting

Not all anti-cancer treatment causes nausea and vomiting. If your treatment is expected to cause nausea, we will give you anti-sickness medication. We will explain the best way to take them.

If you are unsure how to use them or if they are not controlling your symptoms, please contact us.

Hair loss

Not all treatment causes hair loss. Your CNS or chemotherapy nurse will be able to advise you about this. If you would like to be referred for a wig, they can organise this for you.

There will be a charge for your wig. This may be reduced if you are receiving certain benefits.

If you lose your hair, it grows back after treatment has finished but can be different in colour or texture than before.

Fertility

Some cancer treatments can affect your ability to become pregnant or father a child. Options for fertility preservation will be discussed with you if this is a concern.

Many medicines can harm unborn babies and you may need to take precautions to reduce this risk. In some cases, this will be discussed with you specifically. Please ask if you have any concerns.

Psychological issues

A cancer diagnosis can cause many different feelings and emotions. People react in different ways and there is no right or wrong way to feel.

If you are feeling overwhelmed and/or distressed, please feel free to speak to any of the Haematology team about your concerns.

Treatment and your daily routine

Work

Whether you continue to work or not throughout treatment will depend on you, your job, and the environment you work in. Please discuss this with your nurse or consultant.

We are happy to support you in letting your employer know what is going on and helping you access financial support and advice.

Driving

You do not have to inform the DVLA that you have cancer or are having treatment. We recommend that you do not drive to your first treatment session as it is difficult to know how you may be affected. For example, some medicines can make you feel drowsy. If you are feeling at all unsafe then do not drive. In some cases, we can offer hospital transport to and from hospital.

If you are receiving treatment at North Bristol NHS Trust, you are entitled to a free car parking pass. This is valid for up to 3 months and is renewable for as long as you need it. Please ask the CNS or chemotherapy staff for details.

Exercise

Exercise means different things to different people. Research has shown that some gentle exercise has been beneficial to patients undergoing treatment. However, this does depend on how you feel. It is important to not push yourself too much.

If you feel tired or fatigued, it is important to rest. However sometimes getting out for some fresh air or to walk the dog can be just as beneficial. We can refer you to a physiotherapist if you need help dealing with fatigue or returning to normal activity levels.

Going on holiday

We usually recommend that you do not travel abroad during treatment. Your doctor can advise you about having a holiday within the UK. If your blood counts are satisfactory and you feel well, you may benefit from a short break within the UK. It is important that your life is not completely put on hold during this difficult time.

If you become unwell when you are away from home do not attempt to return to Bristol before seeking help. Please go to the nearest hospital with an emergency department. Take your chemotherapy alert card with you and provide as much information as you can about your diagnosis and the treatment you are having.

Financial issues

Living with cancer can have a significant impact on your income and the cost of living. There is a team of benefits advisors provided by Macmillan and the Citizens Advice Bureau. Talk to your CNS or the team at the Macmillan Wellbeing Centre and ask to be referred.

You may also be able to apply for a grant from Macmillan to help with the cost of living with a cancer diagnosis.

If you have a cancer diagnosis you are entitled to free NHS prescriptions. If you do not already have exemption from prescription charges, please ask the CNS about this.

Your support team

Clinical Nurse Specialist (CNS)

Everybody with a cancer diagnosis has access to a specialist nurse or Macmillan nurse.

The nurse is here to provide you and your family with the support and information you need before, during, and after your treatment. For most people with a haematological cancer the CNS will be your ‘Key Worker’ and your point of contact with the Multi-Disciplinary Team responsible for your care.,

You should see the CNS before you start your treatment. Whenever possible this will happen in the outpatient clinic or Medical Day Unit at the same time as another appointment.

Our CNSs work Monday to Friday from 09:00 to 17:00 and can be contacted by phone or email. Please be prepared to leave a message when you call.

Phone: 07545 421893

Email: haematologyCNS@nbt.nhs.uk

Acute Oncology Nurses

The Acute Oncology Nurses work Monday-Friday, 08:00-16:30, and you can phone them 07860 783116.

The Acute Oncology Service provides specialist advice and support for cancer patients with urgent problems related to their illness or treatment.

They can advise the best thing to do, whether this is to attend hospital or your GP for assessment.

Cancer Support Workers

Cancer Support Workers work with the Clinical Nurse Specialist team and cancer team. They provide support and advice to patients at the time of diagnosis, during, and after treatment.

They are trained to provide support and information about physical, emotional, and practical concerns to help you self-manage your recovery and return to a healthy lifestyle as soon as possible.

Support is provided face to face, over the phone, or by email.

NGS Macmillan Wellbeing Centre

The Wellbeing Centre is located opposite the main hospital entrance at the end of the car park, next to the Breast Care Centre. We offer help and information about different kinds of cancers and treatments. We also talk about, finances and benefits, diet, exercise, and emotional support. We are here to listen to you and the people who support you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 to 16:15

Phone: 0117 414 7051

Other information and support

Blood Cancer UK

Information and support for everyone affected by all blood cancers. Leukaemia, lymphoma, myeloma, MDS, MPN.
Blood Cancer UK | We're here to beat blood cancer
Phone: 0808 2080 888

Cancer Research UK

Information service about cancer and cancer care for people with cancer and their families.
Cancer Research UK
Phone: 0808 800 4040

Leukaemia Care

Information and support for people living with leukaemia, MDS and MPNs
Leukaemia Care - The UK's leading leukaemia charity
Phone: 0808 801 0444

Lymphoma Action

The UK's only charity dedicated to lymphoma.
Lymphoma Action
Helpline: 0808 808 5555

Macmillan Cancer Support

Offers a range of support for the emotional and practical impacts of living with cancer.
Macmillan Cancer Support | The UK's leading cancer care charity
Support Line: 0808 808 0000

MDS UK Patient Support Group

Supports anyone affected by MDS or CMML. Providing reliable information and support.
Home | MDS UK Patient Support Group
Phone: 020 7733 7558

MPN Voice

MPN Voice’s mission is to provide clear and accurate information and emotional support to everyone who has been diagnosed with a myeloproliferative neoplasm (MPN) and their families/friends.
MPN Voice – mpnvoice.org.uk
Phone: 07934 689 354

Myeloma UK

Provides information and support to anyone affected by myeloma. Offers support groups, discussion forums and Infoline. Includes related disorders including AL amyloidosis, Monoclonal Gammopathy of Undetermined Significance (MGUS) and Plasmacytoma.
Homepage - Myeloma UK
Info line: 0800 980 3332