Email: HaematologyMMR@nbt.nhs.uk

Clinical Nurse Specialist
07545 421893
If no answer, please leave a message. We aim to respond within two working days. 

You have had a cystoscopy (where a special telescope is passed into your bladder), an ultrasound scan, or an X-ray which shows that you have a tumour in your bladder.

Bladder cancers grow and look like warts or mushrooms on the lining of the bladder. As they develop, they can put down deeper roots into the muscle wall of the bladder (this is called a muscle invasive tumour). Most bladder cancers are small. They are called superficial (or non-muscle invasive) bladder cancers and are confined to the inner lining of the bladder only.

Benefits 

By removing the tumour, we can analyse the samples under a microscope to find out more about whether your condition is cancerous, assess what type of cancer this is and how far it has gone into the bladder wall. This information will help us plan any further treatment you may need.

Risks

Common (almost all patients will experience):

• Need for a period of catheterisation (a catheter is a tube placed into the bladder, to drain your urine) post-operatively.
• Mild burning or bleeding for a short time after the operation. It is normal for this to happen after your operation and will ease over 10-14 days.

Less common (between 1 in 10 and 1 in 50) patients will experience:

• Infection of your bladder requiring antibiotic treatment.
• Recurrence of the tumour (it grows back after removal) and/or incomplete removal.

Rarely (between 1 in 50 and 1 in 250) patients will experience:

• Delayed or ongoing bleeding requiring further surgery or readmission to hospital.
• Damage to the ureters (pipes draining your kidneys).
• Injury to your urethra (waterpipe) causing delayed scarring and a stricture (narrowing).
• Perforation (a hole) in your bladder requiring a catheter for a prolonged period or open surgical repair.
• Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus (lung clot), deep vein thrombosis (leg clot), heart attack and death). Your anaesthetist can estimate your individual risk.

The surgeon will discuss with you how likely any of these are and how they are treated, before your operation.

What are the risks of a general anaesthetic?

Straight afterwards you may feel tired, dizzy, or weak. You must have someone to collect you and stay with you for the first 24 hours. 

During the first 24 hours you should not:

• Drive or operate any motorised vehicle or electrical equipment.
• Sign any legal documents or make important decisions.
• Drink alcohol.

You may feel weak or dizzy at times during the first 7 – 10 days. If this happens, sit down until the feeling passes. 

You may also have the ‘post-operative blues’ and feel a little depressed. If any of these symptoms do not go away, please contact your GP for help and advice.

Removing the tumour is the only reliable way to find out what type of tumour you have. If you do not have the operation and the tumour is a superficial (non muscle invasive) bladder cancer (just on the surface of your bladder), there is a risk that it will change into an invasive cancer or grow bigger if not removed.

If the tumour is a muscle invasive bladder cancer and it is not removed, there is a risk that it will grow deeper into the tissues of your bladder and the cancer may spread to other parts of your body, which could affect your lifespan. In some cases, chemotherapy, immunotherapy, radiotherapy, or cystectomy may be alternative options.

Chemotherapy or immunotherapy – where medicines are instilled into your bladder (for early cancer) or given intravenously (for more advanced cancer). This is not usually performed without samples having been taken from the bladder.

Radiotherapy – where radio waves are aimed at your bladder (usually for more advanced cancers). This is not usually done without samples having been taken from the bladder.

Cystectomy – a major operation to remove the bladder, this is usually an option for more advanced tumours and is not usually done without samples being taken from the bladder first.

If you cannot have a general or spinal anaesthetic, there is an option to perform this operation under a local anaesthetic with a laser (Trans Urethral Laser Ablation – TULA), however, this is not the preferred option, as we do not get as much information about your cancer. TULA is therefore only offered in specific circumstances such as if you are very high risk for complications from a general or spinal anaesthetic.

A request form is completed by the doctor you see in clinic and sent to the waiting list team. 

The request is then processed and a date for pre-op assessment (if you do not have it on the same day as your outpatient appointment) and surgery will be sent to you through the post or by phone. 

Pre-op assessment clinic

At your pre-op assessment, a nurse will take your medical history, explain the type of anaesthetic you will have (usually a general anaesthetic), and what to expect after surgery. They will also answer any questions you may have. 

Please bring details of any medication you are taking or the medicines themselves. Also let the nurse know if you are allergic to any medicines, tablets, or plasters. 

You will have some screening tests. These may include checking. your blood pressure, taking a blood sample or having an electrocardiogram (ECG) to check your heart. 

The nurse will confirm that you are medically fit for your operation as a day case procedure, or if not fit and able for a day case, they explain about staying in hospital overnight. Day case is the standard at North Bristol NHS Trust.

The letter from the hospital will provide full details, but it usually asks you to report to Medirooms, Gate 21, Level 3, Brunel Building, Southmead Hospital.

If you have been given a consent form, please bring it with you. 

What happens during the operation?

• We will usually give you a general anaesthetic (where you are put to sleep) but may also carry out the procedure under spinal anaesthetic (where you have an injection in your back to numb you from the waist downwards).
• Once you are anaesthetised, you will usually have an injection of antibiotics to try to prevent any infections afterwards.
• Your surgeon will then put a telescopic instrument called a cystoscope into your urethra (the tube through which you pass urine) and up into your bladder. The cystoscope is about the thickness of a pencil or a pen and has a tiny video camera on one end, so your surgeon can view an image of your urinary system on a television screen. If your urethra is too narrow, they will gently insert small instruments called dilators to gradually widen the opening.
• Your surgeon will inject sterile salt water (saline) through the cystoscope to help expand your bladder and allow them to get a clear view of the tumour. They will pass small instruments through the cystoscope to collect a tissue sample (biopsy) from inside your bladder. This sample will be sent to the laboratory to be examined.
• Your surgeon will then cut away either part, or all of the tumour. The tumour will be sent to the laboratory for further tests and analysis. Because we do not need to make any cuts on the outside of your body during this procedure, you will not have any visible wounds or stitches.

How long does the operation take? 

The procedure takes about 45 minutes to 1 hour and 15 minutes, depending on the size of your tumour and where it is.

As you had a general or spinal anaesthetic you will go to the recovery area in the theatre department for at least four hours because you will feel drowsy and need time to recover (general) or your legs will still be numb for a few hours (spinal).

You will need a relative, friend, or carer who can escort you home and stay with you for the first 24 hours after your procedure. Please let them know they may have to wait for you if you are not ready to leave.

You may have a urinary catheter left in your bladder after your operation. This is a flexible tube that drains your urine into a bag outside your body. The catheter may also be used to flush out your bladder and wash away any blood clots after surgery (called irrigation). This means you will have a bag of salt solution connected to the catheter which will flow into your bladder. This irrigation will be stopped once your urine runs clear.

The other reason for having a catheter in after this procedure is that you may be offered a dose of intravesical chemotherapy (Mitomycin C) after the operation – Mitomycin C is put into the bladder for an hour using your catheter. This has been proven to help prevent tumours from growing back. Occasionally there may be reasons why this is not suitable, and your surgeon will discuss this with you before the operation.

You may need to have the catheter in anywhere from 2-10 days, depending on what happens during the operation. For most people, this is 2-5 days. Before you leave hospital, you will be given a date to return to hospital for the removal of your catheter (Trial Without Catheter – TWOC). Our nurses will explain how to care for the catheter, and when and where to return to have it removed.

Sometimes we are able to put you on a pathway where you are able to remove the catheter yourself at home (self TWOC). If you are suitable for this, you will be given details of this after the operation.

In most situations, this will be day case surgery and you will be able to go home on the same day, once you have fully recovered. 

Please ask your surgical team for a fit note (sick note) if required.

You may want to go to the loo more often for a while after the catheter has been removed. You may also find it quite sore or painful the first few times that you pass urine. This is normal. It may take several weeks for these symptoms to settle. 

You may pass some blood or small clots in your urine for 10-14 days after your operation. This is normal. Drink plenty of fluids (not alcoholic) to help wash away the blood and ease any soreness. 

We advise you to:

• Speak to your doctor about how much time you will need off work after your operation. This will depend on how quickly you recover and the type of work you do. You usually need to take about 2 weeks off. If your job involves lifting or heavy work, you may need to be away from work for 3-4 weeks.
• Start gentle exercises about a week after your surgery. Please do not do anything too energetic for 1 month, such as playing contact sports like rugby.
• Avoid driving until you feel comfortable and can do an emergency stop. Please check with your insurance provider before starting to drive again.

We may give you antibiotics to prevent you from developing an infection after your operation. Please make sure you take the whole course.

If samples were sent away as part of the procedure, you will be informed of the results 2-3 weeks after the surgery, usually by an appointment with one of our Cancer Nurse Specialists. 

If you have a catheter, we will arrange an appointment for you to have it removed, anytime from 2-10 days after the procedure. This appointment is usually at Urology Outpatients, Gate 36, Level 1, pink zone, in the Brunel Building, Southmead Hospital.

Please do not bring in valuables, jewellery or large sums of money. If this is unavoidable, please ask a relative to take them home for you. The hospital cannot accept liability for the loss of personal items.

For general queries or concerns after your operation, please contact the hospital on: 

Gate 36 (Urology Outpatients): 0117 414 0740 

Urology Cancer Nurse Specialists: 0117 414 0512

It is important to tell the doctor or nurse about any tablets or injections you are taking before you attend for your bone marrow test, as they may have to be stopped for a short while before having the test. This is especially important for medications that thin your blood, for example warfarin, apixaban, rivaroxaban, edoxaban, dabigatran or heparin/enoxaparin. We also need to know about any allergies you may have.

The procedure takes about 15-30 minutes, and you should feel well enough to go home after a short rest. 

You should allow around an hour for this appointment. There are no special preparations, but it is sensible to have something to eat and drink beforehand or you may feel light- headed during the procedure. We recommended you ask a family member or friend to come with you and take you home afterwards. We advise you don’t drive home if possible. 

You will be asked to sign a consent form and will have the opportunity to ask questions beforehand. The procedure is done under local anaesthetic by a doctor or clinical nurse specialist. In some cases, nitrous oxide (gas and air), an inhaled painkiller, can be used. It is safe and it wears off quickly. Please ask if you would like to have this. 

Please ask us if you would like more information about pain relief during the procedure. You can phone us on the number in the how to contact us box.

The bone marrow exists throughout the body, in the cavities of the bones. The most common place to take a bone marrow is at the back of the pelvis (if you place your hands on your hips, the thumbs will be over the place where the bone marrow is taken). Marrow can also be taken from the breast bone (sternum) but this is unusual.

You will be asked to lie on your side with your knees tucked up. The doctor/nurse will first examine you carefully to choose the most suitable site. Then the skin will be cleaned using an antiseptic fluid. Local anaesthetic will be used to numb the skin and the surface of the bone.

The needle is then pushed through the skin and the outer surface of the bone until it reaches the bone marrow. You may feel some pressure as the needle is pushed into the bone. A syringe is then attached to the needle and a small sample of bone marrow is sucked out into the syringe. This produces an uncomfortable sensation, which may shoot down your leg. This only lasts a few seconds. The needle is then withdrawn, and pressure applied to prevent bruising.

If you need to have a trephine sample as well as an aspirate this will be done under the same local anaesthetic. You will again feel pressure and pushing as a new needle is rotated into the bone. You may feel a dull ache as the core is removed. Again, this might travel down your leg.

Once the procedure is complete, pressure is applied to the area to stop any bleeding and a dressing is applied to the area.

You will be asked to lie down and rest for a short time after the procedure to make sure there is no excessive bleeding. 

You may have some discomfort and bruising over the test site for a few days which can be eased with paracetamol. The dressing should be left in place for at least 24 hours while a scab forms. You are advised to keep the site covered for a further 2 or 3 days.

As with all medical procedures, there is an extremely rare chance that a problem may occur. These can include:

• Bleeding: in a small number of cases there is some bleeding from the biopsy site. This usually stops by itself. Very rarely the bleeding is more severe and may require a blood transfusion. If you are taking blood thinners, please inform us before attending for your bone marrow.
• Infection: there is a very small risk that the small wound may become infected. Please contact us if you are concerned.
• Allergy: rarely you may have an allergic reaction to the anaesthetic, cleaning solution, or dressing.
• Damage to nearby structures: rarely the needle damages other nearby structures (for example nerves and muscles).
• Insufficient sample: occasionally, it may be necessary to repeat the procedure if the sample is not of suitable quality for testing in the laboratory.
• Pain: pain should be well controlled after the procedure with simple paracetamol. Please refer to the Post Bone Marrow information if this is not the case.

It would be difficult for your doctor to make the right diagnosis and decide on the correct treatment for your problem.

The laboratory tests can take two to three weeks to complete, depending on the information required. Your doctor will discuss with you when and how you will receive your results.

You will be asked to attend the Medical Day Care Unit at Gate 5b (Room 28) Southmead Hospital for your test.

Medical day care schedulers

0117 414 3206 
0117 414 3205
09:00 - 16:00

Clinical Nurse Specialist 

07545 421 893 
This number has an out of hours answer machine. We will get back to you within one working day.

You can be referred at any stage of your baby’s admission to NICU.

If you would like to be referred, please ask any member of your hospital care team such as your baby’s nurse.

• You will be contacted to arrange a time to meet, either in hospital or via phone/video call if you prefer.
• The psychologist can see you on your own or with your partner or other family members. It is your choice.
• If you require an interpreter, please let us know.
• The first meeting is an opportunity to talk about what is most challenging for you. We can think together about what might support you while your baby is in NICU.
• There may be a small wait for appointments.
• Sometimes we have trainees working in the team, all of whom are supervised. We will check first to see if you are comfortable meeting with a trainee.
• Sometimes, it may be enough to meet with a psychologist once or twice, other times you may wish to meet more regularly.

Any information you share with the psychologist is confidential. This means it will not be shared without your permission unless there is concern about risk of harm to you, your child, or others.

Parents sometimes find it useful to share information with the clinical team to help them understand the best way to communicate with you, and care for your baby.

Notes from your conversations are documented in your hospital record, this is separate to your baby’s medical notes. A brief record of contact is made in your baby’s medical notes to the clinical team are aware the psychologist has met you.

The decision to use the psychology service is entirely up to you. If you decide not to, it will not affect your baby’s care.

This page on the North Bristol NHS Trust website has links to many organisations who provide support and information to parents of babies in the neonatal unit: NICU Useful Links | North Bristol NHS Trust

South West Neonatal Network 

The South West Neonatal Network have put together virtual tours of the neonatal units in the area as well as the ambulances that transfer neonatal babies in the region. You may find this useful to look at before your first visit: SW Neonatal Units — South West Neonatal Network

You can contact our team Monday to Friday (excluding bank holidays) 09:00 to 16:00 on 0117 414 6818. 

You can ask any of your baby’s care team to contact us on your behalf and they will be happy to help. 

We hope you are pleased with the psychological service you receive.  

Our service is continually developing and reviewing our practice so we can ensure families receive the best support possible. 

When your support from our service comes to an end, you may be asked if you are happy to be contacted for your feedback and views on how the services can be improved. 

If you have concerns about the service you receive from the psychologist, please discuss them with the psychologist or another member of the NICU team. 

If this does not address your concerns, please contact the Patient Experience Team on 0117 414 4569 or email pals@nbt.nhs.uk. 

The intragastric balloon is a minimally invasive procedure where a soft deflated balloon is temporarily placed in the stomach. This is done using a thin tube called an endoscope through the mouth and gullet (oesophagus) under a general anaesthetic (you will be asleep).

Once the balloon is in the top of the stomach it is inflated with blue stained liquid (sodium chloride). This fills part of the stomach and makes you feel full.

The aim is to help change your eating pattern, reduce the volume of food you eat, and make you feel full quicker and for longer. The balloon is normally left in for 6-12 months. After this it must be removed as it may start breaking down.

Most people will have some short-term complications. These include abdominal discomfort and gastrointestinal symptoms like nausea, vomiting, acid reflux, and dehydration. You will be given medication to take home to help relieve these symptoms.

If symptoms don’t go away and you are vomiting, or unable to have any food or drink please go to an Accident and Emergency Department.

Other risks of having an intragastric balloon are: 

• Intestinal obstruction by the balloon.
• Bleeding or gastric perforation.
• Balloon rupture and migration.
• Gastric ulcers and oesophagitis.
• Sepsis.
• Pancreatitis.

The chance of these risks happening are very small, but you should be aware of them before agreeing to the procedure.

Once you have a date for your procedure, you will be sent an appointment to attend the pre-assessment clinic. A nurse and anaesthetist will check you are well enough to have surgery. You will be advised at your pre-operative assessment:

• When to stop eating and drinking before your operation.
• What medicines to take/not take on the day of the procedure.

The procedure is a day case and most people will go home that evening. Someone over the age of 18 years old will need to stay with you overnight as you will be having a general anaesthetic and may feel very sick.

After the procedure you will feel a little groggy but this will soon wear off.

You might feel quite thirsty and like your mouth is dry, but it is important not to drink quickly and gulp. This will make you be sick and might cause pain. Start with drinking some water from a tea spoon. Sip the fluid one spoon at a time and stop if you feel any pain. Slowly increase the amount of fluid that you are able to take.

If you get thirsty at home, make sure you keep sipping little and often and try sucking an ice lolly or ice cube.

After having the intragastric balloon inserted you may feel extreme nausea for up to 72 hours. It’s very important to take the following medication which will be given to you before leaving hospital:

• Proton Pump Inhibitor (protects your stomach):
  • Lansoprazole.
• Anti-sickness medication:
  • Cyclizine.
  • Ondansetron.
  • Prochlorperazine Buccal.

You will need to buy over the counter chewable A-Z multivitamins and take them twice a day. This will help you get enough vitamins while you are eating and drinking less. 

Once you have the balloon it is important to eat slowly and keep hydrated. Aim to drink 200mls an hour and avoid drinking 20 minutes either side of eating. Have a sip of water 30 minutes after eating to ‘rinse’ the balloon.

Remember, sip drinks slowly. You might find it helpful to carry a sports bottle around with you. Sips little and often are important to make sure that you stay well hydrated.

You need to follow a liquid and soft diet for the first 2 weeks after the balloon has been inserted. Then you can gradually move towards normal diet.

Days 1-7: runny fluids

• Water.
• Low calorie fruit squash.
• Weak tea or coffee.
• Clear soup or broth.
• Sugar-free jelly.
• Low fat/low sugar yoghurt drinks.
• Skimmed milk.
• Flavoured sugar-free water.

Day 8-10: thick fluids

Try introducing thicker fluids such as:

• Smooth soups such as tomato.
• Yoghurt drinks.
• Sloppy Ready Brek or Weetabix.
• Fruit and yoghurt smoothies.
• Milkshakes.

Day 11-14: soft food

Aim to gradually introduce soft textured food that can be mashed with the back of your fork. You will need to do this slowly. If you feel uncomfortable when you eat, take a break, wait, and then try another mouthful.

Here are some examples:

• Cottage cheese.
• Scrambled eggs.
• Porridge.
• Canned tuna with light mayonnaise.
• Lasagna.
• Bolognese sauce.
• Home made soups.

Day 15: solid food

Start introducing a diet of normal texture food, high in protein with the aim of a healthy balanced eating.

You will not feel like eating as much as before and if you eat fatty foods or sweets, you may feel nauseated.

Aim for 3 small meals a day with 2-3 high protein snacks if you can. Limit or avoid bread, pasta, and rice as these can stick to the balloon and cause bad breath and increase risk of nausea and heartburn.

A helpful technique to use is called ‘20, 20, 20 rule’. This involves:

1. Cutting your food to the size of a 20 pence piece.
2. Chewing 20 times before swallowing.
3. Leaving 20 minutes between bites.

An extra ‘20’ is to stop eating after 20 minutes to give you time to recognise how full you are feeling. You can always add a little more, but you want to avoid feeling overfull or being sick.

Regular overeating, to the point where you feel sick, can be dangerous with a balloon in place. If you are struggling to manage your eating, please reach out for support.

Drinking alcohol in moderation will not affect your balloon but the extra calories will not help your weight loss.

Possible problems

• Vomiting – if you vomit, stop eating for at least 2 hours then drink a small amount of water and proceed with soft foods again when you can. Aim to get back to solid foods. If the vomiting continues, or you are unable to drink fluids, contact your GP or go to A&E. Some people will need the balloon to be removed in the first few weeks because of severe nausea.
• Reflux – avoid eating late at night and wait at least 2 hours after eating before going to bed. The balloon tends to move up when you lie down and could cause reflux. If you have reflux in the evening avoid coffee, tea, and alcohol. Raise your bed at the head end and avoid certain foods which may make these symptoms worse.
• Smelly breath – this can be caused by food becoming trapped around the balloon. Try to drink water 30 minutes after eating to help clear the balloon.

The balloon can work as a tool to help you feel fuller for longer and reduce your overall food intake. If you are not noticing any difference in your hunger or fullness please contact the team for support.

The balloon will not necessarily take away the feeling of ‘head hunger’ or emotion-based urges to eat. These can be difficult to manage, please reach out to the team for support if you are struggling to manage these.

If you feel a craving coming on, you may find it helpful to focus on why you decided to start this journey and to have the balloon.

Think back to what has helped manage urges in the past, common techniques include:

• Identify the feeling: Is this a physical hunger? In which case, have a high-protein snack or meal. Is this a head hunger? Try the below:
  • Urge surfing: notice the feeling, rate the craving from 1-10, wait 20 minutes (distract yourself) then rate the feeling once again – usually it will have significantly reduced if not disappeared.
  • Distraction: arts and crafts, music, game on your phone, go for a walk, call a friend, taking yourself away from the kitchen/shops can be helpful.
  • Create an emotional toolbox: when I feel x (emotion) I will do x/y/z (action).
  • Plan your next meal/snack: sometime cravings happen when you are unsure where your next food is coming through – planning can help manage this.

Bariatric Coordinator:

• 0117 414 0855
• 0117 414 0854

Bariatric Clinical Nurse Specialist:

• 0117 414 7557
• 07557 312784

• 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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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

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 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.

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

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

Penny Brohn

Health and wellbeing support for people living with cancer.
Penny Brohn UK – Cancer wellbeing for everyone
Phone: 0303 3000 118

NHS website

Offers general health information
NHS website for England - NHS

Haemotology Clinical Nurse Specialists

Monday-Friday, 09:00-17:00
07545 421 893

Acute Oncology Nurse

Monday-Friday, 08:30-16:00
07860 783 116

Chemotherapy Suite

Monday-Friday, 09:00-17:00
0117 414 3580

Clinical Hub (out of hours)

0117 414 0700

R&I - (PO1) Commercial Research Policy

R&I - (PO2) Sponsorship & Central Trial Management Fees Policy

R&I – (P03) Excess Treatment Costs In Research at NBT has been suspended. All new research projects with excess treatment costs require approval from the General Manager/Clinical Director.

R&I - (PO4) NIHR Research Funding Recovery Policy

R&I - (PO5) - PPI in Research Payment Policy

RD - (P06) Research Misconduct Policy

NBT (CG-134) Adult Safeguarding Policy

NBT (CG-197) Safeguarding Children Policy

NBT (PEO-33) Fairness at Work Policy

Guidance on Allocation of Research SPA time for Consultants

R&I NBT HRA Checklist

R&I Making amendments to NBT Sponsored studies that have HRA approval

R&I Setting up new studies where NBT are sponsor

Ref: RD/QMS/SOP/001 : Preparation of Research Standard Operation Procedures

Ref: RI/QMS/SOP/002 : Obtaining R&I Confirmation for Research to Start

Ref: RD/QMS/SOP/003 : Research Study Amendments

Ref: RI/QMS/SOP/004 : Maintenance of Research Equipment SOP

Ref: RI/QMS/SOP/005 : Research Staff Training

Ref: RI/QMS/SOP/006 : Honorary Research Contract Letters of Access SOP
Ref: RI/QMS/SOP/006a External Researcher Information Form

Ref: RI/QMS/SOP/007 : Applying for NBT Sponsorship SOP
Ref: RI/QMS/SOP/007a Sponsorship Request Form
Ref: RI/QMS/SOP/007b NBT Terms of Sponsorship
Ref: RI/QMS/SOP/007c Delegation of Responsibilities
Ref: RI/QMS/SOP/007e Declaration Form
Ref: RI/QMS/SOP/008 : Writing a Protocol for ctIMPs
Ref: RI/QMS/SOP/009 R&I Periodic Reporting to Regulatory Authorities
Ref: RI/QMS/SOP/010 : Archiving
Ref: RI/QMS/SOP/011: R&I Closing Suspending and Terminating Research

Ref: RI/QMS/SOP/012 : R&I Managing Breaches of GCP or the Protocol
Ref: RI/QMS/SOP/012a : ICH GCP NonCompliance Report Form
Ref: RI/QMS/SOP/012b Identifying & preventing noncompliance with Good Clinical Practice or the protocol
Ref: RI/QMS/SOP/012c : Protocol Deviation Review & Analysis Form
Ref: RI/QMS/SOP/013 : R&I Safety Reporting
Ref: RI/QMS/SOP/014 : R&I Monitoring
Ref: RI/QMS/SOP/015 : R&I Computer System Validation & Backup
Ref: RI/QMS/SOP/016 : R&I Research Contracts & Vendor Selection
Ref: RI/QMS/SOP/017 : R&I Data Management
Ref: RI/QMS/SOP/018: R&I Management of Fridges & Freezers
Ref: RI/QMS/SOP/019 : R&I RESTART During urgent public health emergencies
Ref: RI/QMS/SOP/020 : Management of healthy volunteers in research
Ref: RI/QMS/SOP/021 : R&I Informed Consent in Adult Research Setting

At North Bristol NHS Trust, we are committed to ensuring that all research conducted within our organisation upholds the highest standards of ethical integrity, safeguarding the rights, dignity, safety and wellbeing of everyone involved.

We support high-quality, ethical research that contributes to improving patient care, public health, and service delivery.

Ethical Review Process

All research involving our patients, staff, data or facilities must receive appropriate ethical review and approval before it begins. This may include:

• Review by a Health Research Authority (HRA) Research Ethics Committee (REC) – required for most research involving patients or identifiable NHS data.
• Local review through the Trust’s Research & Development (R&D) Department, which ensures projects meet NHS and Trust-specific governance requirements.

We work closely with the HRA to ensure compliance with the UK Policy Framework for Health and Social Care Research and all relevant legal and ethical standards, including GDPR and the Declaration of Helsinki. 

The HRA provides comprehensive guidance on the ethical review process, including the roles and responsibilities of RECs to ensure that we protect the rights, safety, dignity and wellbeing of participants.

This centralised approach ensures consistency and rigour in the ethical review of health and social care across the UK.

You can find out more information here: 

• HRA guidance – Applying to a Research Ethics Committee

Supporting Researchers

Our R&D team offers support and guidance throughout the ethical approval process. We help researchers:

• Identify the appropriate level of ethical review
• Prepare and submit applications via the Integrated Research Application System (IRAS), including development of the required submission documents such as research protocol, participant information sheets and consent forms.
• Understand key ethical considerations such as consent, confidentiality, risk, and public involvement.

If you are planning a research project, please contact our R&D team early in your planning process to ensure ethical requirements are met, as part of our sponsorship review process.

Contact Us

For further information or support with research ethics, please contact:

Research and Development

Research Sponsor
North Bristol NHS Trust
Email: researchsponsor@nbt.nhs.uk
Phone: 0117 414 9330