Haematology

 Further content for this area is in development

• British Society for Haematology - Guidelines

• UKONS Acute Oncology Initial Management Guidelines 

• Management of Cancer-Associated Thrombosis

• Neutropenic Sepsis

•   Myeloma  

CAR T Guidance  The Leukemia & Lymphoma Society has created a youtube video about the possible side effects from CAR T-cell Therapy to help answer questions that patients may have. This video explains the goal of CAR T-cell therapy and side effects that a patient may experience.  

Acute oncology services span haemato-oncology and solid tumour oncology patients. Many trusts run a joint Acute Oncology service for  haemato-oncology and solid tumour oncology – we would like to include some information about these services and how they have developed.

Please contact us if you would like to tell us about your service.

Service development example: The Haematology Ambulatory Care Service at Leicester Royal Infirmary 

This service started last July there is 1 full time nurse post for the service (currently a job share). 

Our aim is to facilitate outpatient care for patients undergoing systemic anti cancer treatment (SACT) for Acute Myeloid Leukaemia and Acute Lymphocytic Leukaemia as well as patients with myeloma and lymphoma having stem cell transplants. We have ambitions to expand the scope of patients we can encompass as the service grows including patients receiving high dose chemotherapy for lymphoma.

A patient, for example, with Acute Leukaemia would have traditionally spent 4-6 weeks per cycle of chemotherapy as an inpatient in hospital- which to receive the standard 4 cycles of chemotherapy required would mean that the patient could be an inpatient for 6 months. 

We give chemotherapy through a combination of ambulatory chemotherapy pumps and outpatient chemo as a day case depending on the regime and we then support the patients through the neutropenic phase of their chemotherapy recovery with regular outpatient appointments.

We have just completed our first year of the service and in that time have prevented 845 overnight stays in hospital. The benefits that this has had on patients and their families is immeasurable and we feel incredibly humbled to be a part of their ambulatory care journey.

Ambulatory Care allows control to shift back to where it belongs - with the patient.  Ambulatory patients can take ownership of their care with the support and  guidance of their specialist nurses, doctors and pharmacists.’

We are more than happy for people to contact us for more information- email address  ambulatorycarenurses@uhl-tr.nhs.uk

Added to site 16/09/2021

Service development:  Developing a combined Haematology and Oncology Acute Assessment Unit

Dr Laura Percy, Consultant Haematologist, at the University Hospitals Bristol and Weston NHS Foundation Trust has been involved in setting up a joint acute assessment unit for haematology and oncology patients. 

Prior to the COVID pandemic, the haematology & oncology departments at Bristol Haematology & Oncology Centre (BHOC) had separate outpatient services for clinics, chemotherapy, supportive care and acute assessment within the same building which also contained inpatient wards for oncology, haematology and bone marrow transplant patients. For haematology patients a single outpatient area was used for urgent clinical reviews for unwell patients, procedures (e.g. BM biopsies), chemotherapy, blood product support and intravenous immunoglobulin during working hours. This was a great system for those referring in, but the unpredictable workload created a stressful environment for patients and staff alike, and staff retention was challenging. The oncology patients had a dedicated area for chemotherapy, and a nurse-led bay within the oncology ward providing a 24hr acute assessment unit, staffed by advanced nurse practitioners (ANPs). 

In order to reduce patient footfall into our most vulnerable clinical areas as COVID cases increased, the outpatient haematology & oncology chemotherapy and supportive care services were moved to a different building. This created an opportunity to pull together the two different acute assessment teams, within the main BHOC building. However there were obviously challenges, bringing together different specialist nursing teams and different approaches. Additionally the haematology nursing team had enjoyed the variety of acute assessments, chemotherapy administration, etc. and the opportunity to get to know a smaller patient group.

As things returned to something more normal, with falling rates of COVID infections, the BHOC team decided to continue with a joint Acute Assessment Unit (AAU), to better utilise the physical clinical space, keeping an area which would also be suitable for reviewing patients requiring isolation, due to their vulnerability or their symptoms. A number of factors helped to develop a strong combined Acute Assessment Unit. We set up a working group with representation from the haematology & oncology clinical teams, supported by the existing ANPs. They were very proactive and enthusiastic about developing their haematology expertise, and this set the tone amidst the wider nursing  group. They were supported by new clinical practice facilitators recruited from both haematology & oncology backgrounds, to build the skills of the AAU team. They have developed an in-house triaging training, covering all the major oncology & haematology emergencies. We have drafted new eligibility criteria for attendance, to ensure a more permissive approach for the haematology patients, and to allow the AAU to be used for urgent diagnostic workup as well as SACT-related complications. This has been part of a wider shift towards more joint working within BHOC, for example within the chemotherapy unit and clinical governance teams. The wider teams have really valued having a more robust AAU, with 24/7 hours, and the AAU junior doctors have appreciated the opportunity to develop their expertise in both specialities. The patients benefit from a dedicated unit offering expert care in symptom management and rapid workup of complications or new diagnoses.

It is still a work in progress and there are still ‘cultural’ divisions between oncology and haematology, but so far the experience of working together has been really positive and I think there will be wider gains within our whole unit.

Added to the site 15/10/2021