Detailed table of contents

Foreword

Acknowledgements

List of contributors

List of abbreviations

Quick reference to the procedure guidelines

How to use your manual

Introduction

Overview
Evidence-based practice
What is evidence-based practice?
Grading evidence in The Royal Marsden Manual of Clinical Cancer Nursing Procedures
Structure of chapters
Conclusion
References

CHAPTER 1 Diagnostic investigations

Overview
Diagnostic tests and investigations
Tumour markers
Cervical uterine smear
Diagnostic radioisotope procedures (nuclear medicine)
Transrectal ultrasound (TRUS)  prostate biopsy
Flexible cystoscopy
Breast diagnostics
1. Clinical breast examination
2. Core biopsy
3. Breast fine-needle aspiration (FNA)
4. Breast punch biopsy
5. Nipple discharge smear
Genetic testing
1. Websites
2. References

CHAPTER 2 Haematological procedures

Overview
Bone marrow procedures
1. Aspiration and trephine biopsy
2. Bone marrow harvest
Apheresis
Ribavirin administration
Pentamidine isetionate administration
1. Websites
2. References

CHAPTER 3 Cancer pain assessment and management

Overview
Cancer pain assessment and management
1. Pain management
2. Acupuncture
Interventional techniques for managing complex cancer-related pain
1. Single nerve blocks and injections
2. Regional peripheral and plexus nerve blocks and infusions
3. Neuraxial (spinal) blocks: epidural and intrathecal analgesia
Entonox (nitrous oxide) administration
1. References

CHAPTER 4 Administration of systemic anticancer therapies

Overview
Systemic anticancer treatment
Safe handling of hazardous drugs
Administration of cytotoxic medications by nurses
Intravenous administration of systemic anticancer therapy
1. Extravasation
Oral administration of systemic anticancer therapy
Intramuscular and subcutaneous administration of cytotoxic drugs
Topical application of cytotoxic drugs
Intrathecal administration of  cytotoxic drugs
Intrapleural instillation of cytotoxic drugs
Intravesical instillation of cytotoxic drugs
Intraperitoneal instillation of cytotoxic drugs
Intra-arterial administration of cytotoxic drugs
Side-effects of chemotherapy
1. Haematological side-effects
2. Fatigue
3. Gastrointestinal side-effects
4. Adverse drug reactions
5. Neurotoxicity
6. Mucositis/stomatitis
7. Nephrotoxicity/haemorrhagic cystitis
8. Cardiotoxicity
9. Pulmonary toxicity
10. Hepatotoxicity
11. Skin toxicities
12. Alopecia
Clinical research
1. References

CHAPTER 5 Radionuclide therapy

Overview
Radiation
Radiation protection
Unsealed source therapy
Sealed source therapy
Sealed source iodine-125 seeds used in prostate malignancies
Intraoral sealed sources
1. Websites
2. References

CHAPTER 6 Wound management

Overview
Malignant fungating wounds
1. Wound assessment
2. Treatment options
3. Principles of the management of dressings for a malignant fungating wound
4. Local wound management
Graft-versus-host disease wounds
1. Definition
Skin care following radiotherapy
1. Websites and useful addresses
2. References

CHAPTER 7 Acute oncology

Overview
Haematological emergencies
1. Central venous access device complications
2. Thrombosis (catheter related)
3. Sepsis
4. Major artery rupture
5. Superior vena cava obstruction
Metabolic emergencies
1. Hypercalcaemia of malignancy
2. Hypomagnesaemia
Side-effects from chemotherapy agents
1. Diarrhoea (chemotherapy and radiotherapy induced)
2. Nausea and vomiting
3. Neutropenic sepsis
4. Pneumonitis
Structural
1. Ascites (malignant)
2. Bowel obstruction (malignant)
3. Metastatic spinal cord compression
4. Pericardial effusion (malignant)
5. Raised intracranial pressure due to malignant disease
6. References

CHAPTER 8 Living with and  beyond cancer

Overview
Section 8.1 Introduction
1. The experience of living with or beyond cancer
Section 8.2 Welfare advice
1. Overview
2. Websites
3. Useful addresses
Section 8.3 Supporting individuals with sexual concerns as a consequence  of cancer
Women’s sexual concerns following cancer
1. Interventions
Men’s sexual concerns following cancer
1. Interventions
2. Websites
Section 8.4 Nutritional status
1. Websites
Section 8.5 Compression  therapy in the management  of lymphoedema
1. Lymphoedema
2. Assessment of the patient with lymphoedema and calculation of limb volume
3. Compression bandaging
4. Compression garments
5. Adjustable wrap compression systems
6. Websites
Section 8.6 Non-pharmacological management of breathlessness
Non-pharmacological support
Websites
Section 8.7 physical activity for people with cancer
Websites
Section 8.8 Cancer-related fatigue and sleep
1. Cancer-related fatigue
2. Sleep
Section 8.9 communication for a patient with a laryngectomy
1. Websites and useful addresses
Section 8.10 Nipple tattooing
1. References

CHAPTER 9 End of life care

Overview
Last Offices
1. Websites and useful addresses
2. Online resources
3. References

Index

EULA

List of Tables

Chapter 1

Table 1.1 Common tumour markers and clinical application
Table 1.2 Pre-analytical/pre-procedural considerations
Table 1.3 Radionuclide investigations
Table 1.4 Possible side-effects of transrectal ultrasound and prostate biopsy
Table 1.5 TNM classification of bladder cancer
Table 1.6 Benign breast changes across ages
Table 1.7 Proportion of cancer that is inherited

Chapter 2

Table 2.1 The main function of blood cells and the haematological values for normal adults
Table 2.2 Comparison of bone marrow aspiration and trephine biopsy
Table 2.3 Apheresis applications and indications

Chapter 3

Table 3.1 The use of adjuvant drugs (co-analgesics)
Table 3.2 Recommended conversion rate guide from oral morphine to 72-hour fentanyl patch
Table 3.3 Examples of regional analgesia blocks
Table 3.4 Example of competency role development profile for epidural analgesia for pain. Intended learning outcomes and elements of practitioner competency
Table 3.5 Optimal catheter location for different anatomical sites
Table 3.6 Epidural/intrathecal infusions of local anaesthetic agents and opioids: management of side-effects
Table 3.7 Epidural/intrathecal analgesia: safety checklist

Chapter 4

Table 4.1 Types of central venous access device (CVAD)
Table 4.2 Nursing assessment of extravasation
Table 4.3 Grading scale for monitoring extravasation
Table 4.4 Examples of oral anticancer medications
Table 4.5 Counselling checklist
Table 4.6 Oral anticancer administration table for patients with swallowing difficulties
Table 4.7 An overview of clinical trial phases

Chapter 5

Table 5.1 Therapeutic treatments

Chapter 6

Table 6.1 Some assessment tools for fungating wounds
Table 6.2 Significance of the colour of exudate
Table 6.3 Significance of exudate consistency
Table 6.4 Dressings and equipment for the management of wound exudate
Table 6.5 Dressings and agents for the management of wound malodour
Table 6.6 Dressings and agents for the management of bleeding wounds
Table 6.7 Dressings and agents to manage wound pain
Table 6.8 Dressings and agents for the management of pruritus
Table 6.9 RTOG radiation skin reaction scores
Table 6.10 Factors that increase the risk of skin reaction severity
Table 6.11 Skin care advice during radiotherapy

Chapter 7

Table 7.1 Examples of oncological emergencies, cancer of origin, signs and symptoms
Table 7.2 Central venous access devices: most common uses and advantages
Table 7.3 Symptoms of acute and chronic hypercalcaemia according to anatomical system
Table 7.4 Initial actions on suspicion of hypercalcaemia
Table 7.5 The four Ms to monitor if a patient is at risk of acute kidney injury (AKI)
Table 7.6 Grading and management of hypomagnesaemia
Table 7.7 Categories of chemotherapy-induced gastrointestinal tract injuries
Table 7.8 Common Terminology Criteria for Adverse Events grades of diarrhoea and UKONS triage grading
Table 7.9 Potential causes of nausea and vomiting in cancer patients
Table 7.10 Common causes of nausea and vomiting in cancer patients and treatment options
Table 7.11 Drugs used to control emesis and their classification. This list is not exhaustive; each trust may have local clinical guidelines
Table 7.12 Severe sepsis care bundle
Table 7.13 The metastatic spinal cord compression (MASCC) scoring system adapted for local use at The Royal Marsden for grading neutropenic sepsis risk
Table 7.14 Clinical management of pneumonitis induced by targeted therapy

Chapter 8

Table 8.1 Percentage of patients dying from cancer not claiming Disability Living Allowance or Attendance Allowance in the UK and what this means in monetary amounts
Table 8.2 Eligibility/non-eligibility for Personal Independence Payment (PIP), Attendance Allowance (AA), Carer’s Allowance (CA), Employment and Support Allowance (DWP 2018a, b, c, d, e)
Table 8.3 How often benefits are paid (DWP 2018 a, b, c, d, e)
Table 8.4 Personal Independence Payment assessment criteria tool
Table 8.5 SHIM/IIEF-5 screening tool
Table 8.6 The Royal Marsden Nutrition Screening Tool (RMNST)
Table 8.7 Waist circumference measurement for men and women at which there is an increased relative risk for heart disease, type 2 diabetes and cancer
Table 8.8 Examples of application aids
Table 8.9 Using sequential circumferential measurements to measure limb volume
Table 8.10 Points for consideration when recording sequential circumferential measurements to calculate limb volume
Table 8.11 Example calculation of the total volume of a limb using the formula in Box 8.8
Table 8.12 Calculating the volume difference between the limbs as a percentage
Table 8.13 Compression classes and indications for their use
Table 8.14 Competencies for use of an HME device in a laryngectomy patient
Table 8.15 Competencies for cleaning a voice prosthesis in a laryngectomy patient

Chapter 9

Table 9.1 Common symptoms observed in the terminal phase of life

List of Illustrations

Chapter 1

Figure 1.1 Blood bottles.
Figure 1.2 Specimen pots.
Figure 1.3 The cervix.
Figure 1.4 Vaginal specula and cervical broom.
Figure 1.5 Thermoluminescent dosimeter (TLD) badge.
Figure 1.6 Hand and foot radiation monitor. 
Figure 1.7 The prostate and its zones.
Figure 1.8 Prostate core biopsy.
Figure 1.9 Ultrasound machine and probe.
Figure 1.10 Example of TRUS biopsy equipment.
Figure 1.11 (a) Female urinary system. (b) Male urinary system.
Figure 1.12 Flexible cystoscope.
Figure 1.13 Video stack.
Action Figure 19a Cystoscope deflection.
Action Figure 19b Cystoscope inflection.
Figure 1.14 Male internal bladder structure.
Figure 1.15 (a) Female breast (sagittal section).
Action figure 16a  Vertical pattern.
Action figure 16b Radial spoke pattern.
Action figure 16c  Concentric circular pattern.
Figure 1.16 Biopsy device and needle.
Action Figure 15 Biopsy site skin stretched.
Action Figure 1.19 Punch biopsy technique.
Figure 1.17 Family tree or pedigree.

Chapter 2

Figure 2.1 The stem cell and the blood cells that arise from it. Source: Dougherty and Lister (2011).
Figure 2.2 Common sites for bone marrow examination, arranged in order of preference. Normally, only aspirations and not biopsies are done on the sternum because of its small size and proximity to vital organs. Source: Dougherty and Lister (2011).
Figure 2.3 Patient lying in the left lateral position, with the head to the left, exposing the lower back and gluteal region with the right posterior iliac crest palpated. Source: Dougherty and Lister (2011).
Figure 2.4 Aspiration of bone marrow from the marrow cavity. Source: Dougherty and Lister (2011).
Figure 2.5 (a) Preparation of aspiration smears. (b) Completed aspiration smear. Source: Dougherty and Lister (2011).

Figure 2.6 Trephine biopsy sample. Source: Dougherty and Lister (2011).

Figure 2.7 Bone marrow biopsy equipment including antiseptic skin cleaning agent with sponge applicator, selection of syringes for bone marrow sampling and administration of local anaesthetic, selection of needles for the administration of local anaesthetic, marrow aspiration needle and guard, trephine biopsy needle, cytology slides and coverslips, specimen bottles, sterile dressing and size 11 scalpel.

Figure 2.8 (a) Optia™ cell separator machine during stem cell collection procedure. (b) Therakos Celex™ photophoresis machine.

Figure 2.9 Peripheral venous access for cell separator procedures. Source: Dougherty and Lister (2011).

Figure 2.10 The safe use of ribavirin (Virazole®) – administration record sheet.

Figure 2.11 Nurse wearing personal protective equipment (PPE) for the administration of ribavirin.

Chapter 3

Figure 3.1 Processing of sensory input and motor output by the spinal cord.

Figure 3.2 The pain pathway showing key sites for particular analgesic interventions. NSAID, non-steroidal anti-inflammatory drug.

Figure 3.3 The WHO analgesic ladder.

Figure 3.4 TENS machine.

Figure 3.5 A point used for acupuncture.

Figure 3.6 A point used for pain relief.

Figure 3.7 Points used to treat migraines/headaches.

Figure 3.8 Acupuncture treatment record chart.

Figure 3.9 Gross anatomy of the spinal cord. (a) Posterior view and transverse section through spinal cord. (b) Transverse section of the spinal cord within a cervical vertebra.

Figure 3.10 Branches of a typical spinal nerve, shown in cross-section through the thoracic portion of the spinal cord: transverse section.

Figure 3.11 Distribution of dermatomes.

Figure 3.12 Entonox cylinder and hose.

Figure 3.13 Patient using Entonox demand valve.

Chapter 4

Figure 4.1 The cell cycle.

Action Figure 3 Protective clothing for  spillage kit.

Figure 4.2 Chemotherapy bolus being administered.

Figure 4.3 Vessel health poster.

Figure 4.4 Extravasation.

Figure 4.5 Persistent withdrawal occlusion flowchart.

Figure 4.6 Flowchart of management of extravasation.

Figure 4.7 Decision-making tool for vascular access device.

Figure 4.8 Dexrazoxane fowchart, an extravasation has occurred.

Action figure 14 Mark the area of extravasation.

Action figure 15 Administer lidocaine.

Figure 4.21 Make incisions at the four points of the compass and one small incision for insertion of the cannula.

Figure 4.22 Insert the cannula.

Action figure 24 Flush with 0.9% sodium chloride.

Figure 4.9 Ommaya reservoir.

Figure 4.10 Lung anatomy. (a) Normal lung anatomy showing pleura. (b) Lung demonstrating presence of pleural effusion.

Figure 4.11 Sea-bands on wrist.

Figure 4.12 Paxman machine.

Figure 4.13 Dignitana machine.

Figure 4.14 A clinical trial pathway that highlights the areas that are specific to research nurses.

Figure 4.15 Information requested from study sponsor.

Figure 4.16 An example of a screening study data collection tool.

Figure 4.17 An example of a locally developed patient inclusion/exclusion checklist.

Chapter 5

Figure 5.1 Hand-held contamination monitor. Source: Dougherty and Lister (16).

Figure 5.2 Iridium-192 pins. (a) Iridium single pin. (b) Iridium hair pin. Source: Dougherty and Lister (16).

Figure 5.3 Iridium-192 wire in polythene cannula. Typical assembly in tissue. Source: Dougherty and Lister (16).

Figure 5.4 Interstitial perineal template device. Source: Dougherty and Lister (16).

Figure 5.5 Caesium-137 needles. Source: Dougherty and Lister (16).

Figure 5.6 Gynaecological caesium applicators. Arrangement of brachytherapy sources in the uterus and vagina for treatment of cervical carcinoma. Sources may be active or, more usually these days, afterloaded into applicators along catheters protruding from the vagina. (a) Manchester applicator. (b) Modified Stockholm applicator. (c) Fletcher applicator. (d) Dobbie applicator.  Source: Dougherty and Lister (16).

Figure 5.7 Selectron unit. Source: Dougherty and Lister (16).

Chapter 6

Figure 6.1 Diagram representing vessels and skin in a malignant fungating wound.

Figure 6.2 Fungating malignant wound from recurrent breast cancer – chest wall resurfaced with flap reconstruction. Recurrent nodules arising around and infiltrating the flap.

Figure 6.3 Deep ulcerating fungating malignant wound caused by untreated squamous cell carcinoma of the vulva. 

Figure 6.4 Marjolin's ulcer on a buttock arising in an area of previous skin graft or burn scar.

Figure 6.5 Wound assessment chart.

Chapter 7

Figure 7.1 UKONS telephone triage tool. Source: UKONS (2016). Reproduced with permission of UKONS.

Figure 7.2 UKONS toxicity grading guide. Source: UKONS (2016). Reproduced with permission of UKONS.

Figure 7.3 Algorithm for managing central venous access device (CVAD) related thrombosis. LMWH, low molecular weight heparin.

Figure 7.4 Consensus guideline algorithm for the management of diarrhoea. Adapted from UKONS (2018) and Kornblau et al. (2000). CDT, Clostridium difficile toxin; CRP, C-reactive protein; MC&S, microscopy, culture and sensitivity; SACT, systemic anticancer therapy; SC, subcutaneous(ly); TDS, three times a day.

Figure 7.5 The immune-related adverse event (irAE) gastrointestinal management algorithm. Source: Fecher et al. (2013). Reproduced with permission of AlphaMed Press, permission conveyed through Copyright Clearance Center, Inc.

Figure 7.6 The emetogenic pathway. Source: Harris (2010). Reproduced with permission of Oxford University Press, permission conveyed through Copyright Clearance Center, Inc.

Figure 7.7 The NICE neutropenic sepsis pathway (NICE 2012b). Source: Ford and Marshall (2014) Neutropenic sepsis: a potentially life-threatening complication of chemotherapy. Clinical Medicine, 14(5), 538–542. Reproduced with permission.

Figure 7.8 Peritoneum of female in lateral view. Source: Dougherty and Lister (2015). Reproduced with permission from John Wiley & Sons.

Figure 7.9 Example of sterile equipment tray for abdominal paracentesis. Source: Dougherty and Lister (2015). Reproduced with permission from John Wiley & Sons.

Figure 7.10 Hard collar in situ. Source: Dougherty and Lister (2015). Reproduced with permission from John Wiley & Sons.

Figure 7.11 Log rolling and positioning of patient with spinal cord compression or injury. Note: In practice five people are needed for this manoeuvre. Source: Adapted from SIA (2000). Illustrations © Louise E Hunt and SIA. Reproduced from the Spinal Injuries Association (www.spinal.co.uk/) with permission.

Figure 7.12 Pelvic twist for patient with unstable cervical spine. Note: In practice five people are needed for this manoeuvre. Source: Adapted from SIA (2000). Illustrations © Louise E. Hunt and SIA. Reproduced from the Spinal Injuries Association (www.spinal.co.uk/) with permission.

Chapter 8

Figure 8.1 The recovery package. Source: Macmillan Cancer Support (2013b). © Macmillan Cancer Support 2013.

Figure 8.2 Stratified pathways of care. MDT, multidisciplinary team. Source: NHS Improvement (2011).  © NHS Improvement 2011. This information is licensed  under the Open Government Licence v3.0. To view this  licence, visit http://www.nationalarchives.gov.uk/doc/ open-government-licence/

Figure 8.3 Biometric residence permit. Source: UK Border Agency.

Figure 8.4 Interactive biopsychosocial model of sexuality in the context of cancer, with examples in each domain that influence sexuality. Source: Lindau et al. (2015). Reproduced with permission of Johns Hopkins University Press and Elsevier.

Figure 8.5 Posterior view of the uterus and associated structures. Source: Tortora and Derrickson (2011). Reproduced with permission of John Wiley & Sons.

Figure 8.6 Nurse explaining use of vaginal dilator.

Figure 8.7 Male organs of reproduction and surrounding structures. Source: Adapted from Tortora and Derrickson (2011). Reproduced with permission of John Wiley & Sons.

Figure 8.8 Measurement of waist circumference.

Figure 8.9 Weighing a patient. Source: Dougherty and Lister (2015).

Figure 8.10 Measure between the point of the elbow (olecranon process) and the midpoint of the prominent bone of the wrist (styloid process). Source: Dougherty and Lister (2015).

Figure 8.11 Simplified diagram of the lymphatic system.

Figure 8.12 Mild uncomplicated arm lymphoedema.

Figure 8.12b Severe uncomplicated lymphoedema of the arm. Source: Dougherty and Lister (2011).

Figure 8.13 Moderate uncomplicated lymphoedema of the leg.

Figure 8.14 Measurement of limb volume. Source: Dougherty and Lister (2011).

Figure 8.15 Example of a misshapen limb before bandaging. Source: Dougherty and Lister (2011).

Figure 8.16 Example of a misshapen limb after bandaging. Source: Dougherty and Lister (2011).

Action Figure 5a Bandaging swollen fingers.

Action Figure 5b Bandage is taken under wrist, back over hand, to index finger.

Action Figure 5c Finished bandage.

Action Figure 9 Palm and back of hand are padded out.

Action Figure 10 Rolls of padding are applied firmly in a spiral up the arm, starting around the hand. Extra padding is applied to the elbow crease.

Action Figure 11 Hand is bandaged firmly in a figure of eight using a 6 cm compression bandage.

Action Figure 12 Starting at the wrist, an 8 or 10 cm bandage is used to cover to the top of the arm, in a spiral fashion.

Figure 8.17 a–g Bandaging an arm and the fingers.

Figure 8.18 a–h Bandaging a leg and the toes.

Figure 8.19 Example of elastic compression garment for the leg.

Figure 8.20 Example of elastic compression garment for the arm.

Figure 8.21 Adjustable wrap compression system for the lower leg.

Figure 8.22 Adjustable wrap compression system for the arm.

Figure 8.23 A model of how breathing, thinking and functioning affect breathlessness. Source: Adapted from Spathis et al. (2017). Reproduced with kind permission from the Cambridge Breathlessness Intervention Service.

Figure 8.24 Numerical rating scale.

Figure 8.25 The five recommended resting positions. Source: Dougherty and Lister (2015).

Figure 8.26 A handheld fan.

Figure 8.27 Parts of an aroma stick inhaler.

Figure 8.28 Components of health-related fitness. Source: Saxton and Daley (2010). Reproduced with permission of Springer Science + Business Media

Figure 8.29 A model of the benefits of physical activity. Source: DH (2011). © Crown copyright. Reproduced under the Open Government Licence v3.0, https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Figure 8.30 Modified Borg scale of perceived exertion. Source: https://www.cdc.gov/physicalactivity/basics/measuring/exertion.htm.

Figure 8.31 Physical activity pathway. Source: Department of Health (2012). © Crown copyright 2012. Reproduced under the Open Government Licence v3.0, https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Figure 8.32 The Fatigue Severity Scale (FSS) and Visual Analogue Fatigue Scale (VAFS). Source: Learmouth et al. 2013. Reproduced with permission of Elsevier.

Figure 8.33 Sleep diary. Source: National Sleep Foundation (2016). Reproduced with permission of the National Sleep Foundation.

Figure 8.34 Occupational therapy program – tips and strategies for improving sleep. Source: The Royal Marsden Hospital NHS Foundation Trust (2015).

Figure 8.35 Operative site for surgical voice restoration. Source: Dougherty and Lister (2011). Image courtesy of InHealth Technologies.

Figure 8.36 Voice prosthesis in situ. Source: Dougherty and Lister (2011). Image courtesy of InHealth Technologies.

Figure 8.37 (a) Duckbill Blom-Singer voice prosthesis. (b) Low-pressure ex dwelling Blom-Singer voice prosthesis. (c) Indwelling Blom-Singer voice prosthesis. (d) Non-indwelling (NID) voice prosthesis. Photo courtesy of Atos Medical, www.atosmedical.com. (e) Vega voice prosthesis, indwelling. Photo courtesy of Atos Medical, www.atosmedical.com.

Figure 8.38 (a) Provox laryngectomy tube, (b) Provox laryngectomy tube with HME filter, (c) Provox HME baseplate, (d) Provox HME baseplate with filter in situ.

Figure 8.39 Prosthesis brush.

Figure 8.40 Emergency management of a dislodged voice prosthesis. Source: Speech and Language Therapy Department, Royal Marsden Hospital NHS Foundation Trust. NG, nasogastric; NGT, nasogastric tube; SLT, Speech and Language Therapy.

Figure 8.41 Emergency management of a leaking voice prosthesis. Source: Speech and Language Therapy Department, Royal Marsden Hospital NHS Foundation Trust. ENT, Ear, Nose and Throat; H&N, head and neck; NBM, nil by mouth; NGT, nasogastric tube.

Figure 8.42 Patient with nipple reconstruction before tattooing the NAC.

Figure 8.43 Image of patient after tattoo.

Figure 8.44 Matching the reconstructed NAC to the contralateral side.

Figure 8.45 Choice of pigment colours.

Figure 8.46 Tattoo needle cartridge.

Figure 8.47 Medical tattoo machine.

Figure 8.48 Procedure trolley with equipment including: hand piece for holding tattoo needle, needle cartridge for tattooing, cotton bud, sterile gloves, pigment, medical tattoo machine, sterile gauze, sterile dressing.

Chapter 9

Figure 9.1 Representation of disease trajectories.

Figure 9.2 Mortuary.

Figure 9.3 Viewing room.

List of Procedure Guidelines

Chapter 1

1.1 Cervical uterine smear using liquid-based cytology
1.2 Unsealed radioactive sources for diagnostic investigations
1.3 Transrectal ultrasound (TRUS) prostate biopsy
1.4 Flexible cystoscopy
1.5 Flexible cystoscopy with stent removal
1.6 Flexible cystoscopy with bladder biopsy
1.7 Flexible cystoscopy with argon plasma coagulation (APC)/cystodiathermy
1.8 Clinical breast examination
1.9 Core breast biopsy

Chapter 2

2.1 Bone marrow aspiration and trephine biopsy
2.2 Bone marrow harvest
2.3 Apheresis
2.4 Ribavirin administration
2.5 Pentamidine isetionate administration

Chapter 3

3.1 Acupuncture: preparation and administration
3.2 Epidural/intrathecal sensory blockade: assessment
3.3 Epidural/intrathecal exit site dressing change
3.4 Epidural/intrathecal catheter removal
3.5 Entonox administration

Chapter 4

4.1 Cytotoxic spillage management
4.2 Cytotoxic therapy: intravenous administration of cytotoxic drugs
4.3 Extravasation management: peripheral cannula
4.4 Extravasation: performing flush-out following an extravasation
4.5 Cytotoxic therapy: education for patients on oral cytotoxic drugs
4.6 Cytotoxic therapy: intramuscular administration of cytotoxic drugs (Z-track)
4.7 Cytotoxic therapy: topical application of cytotoxic drugs
4.8 Cytotoxic therapy: intraventricular administration of cytotoxic drugs via an intraventricular access device (Ommaya reservoir)
4.9 Cytotoxic therapy: intrapleural instillation of cytotoxic drugs
4.10 Cytotoxic therapy: intravesical instillation of cytotoxic drugs
4.11 Cytotoxic therapy: intraperitoneal instillation of cytotoxic drugs
4.12 Intra-arterial administration of cytotoxic drugs
4.13 Scalp cooling

Chapter 5

5.1 Radiation protection: major spillage of radioactive body fluids through incontinence and/or vomiting
5.2 Radiation protection: contamination of bare hands by radioactive body fluids
5.3 Radiation protection: death of patient who has received unsealed radioactive source therapy
5.4 Radiation protection: cardiac arrest of patient who has received unsealed radioactive source therapy
5.5 Radiation protection: evacuation due to fire of patients who have received unsealed radioactive source therapy
5.6 Unsealed source therapy: entering and leaving the room of a patient who has received an unsealed radioactive source
5.7 Unsealed source therapy: iodine-131 (oral capsule/liquid): administration
5.8 Unsealed source therapy: iodine-131 mIBG treatment: patient care
5.9 Sealed source therapy: caesium sources (manual or afterloading): patient care
5.10 Sealed source therapy: low dose-rate Selectron treatment
5.11 Sealed source therapy: Selectron applicator removal
5.12 Sealed source therapy: insertion of sealed radioactive sources into the oral cavity

Chapter 6

6.1 Assessing a malignant fungating wound
6.2 Dressing a malignant fungating wound

Chapter 7

7.1 Carotid artery rupture (CAR)
7.2 Abdominal paracentesis
7.3 Log rolling for suspected/confirmed cervical spinal instability
7.4 Positioning for suspected/confirmed cervical spinal instability: pelvic twist to right
7.5 Log rolling for suspected/confirmed thoracolumbar spinal instability
7.6 Early mobilization of the patient in bed

Chapter 8

8.1 Conducting a holistic needs assessment (HNA)
8.1a Developing and actioning a care plan
8.1b Closure and follow-up
8.2 How a patient should make a claim for Personal Independence Payment
8.3 How a patient should make a claim for Attendance Allowance
8.4 How a patient should make a claim for Carer’s Allowance
8.5 How a patient should make a claim for Employment and Support Allowance
8.6 Assessing a patient’s sexual health concerns
8.7 Measuring the weight, height and waist circumference of the patient
8.8 Compression therapy limb volume calculation: lower limb
8.9 Compression therapy limb volume calculation; upper limb
8.10 Compression bandaging (multilayer short-stretch): bandaging an arm and the fingers
8.11 Compression bandaging (multilayer short-stretch): bandaging a leg and the toes
8.12 Elastic compression garments: application to the  leg
8.13 Elastic compression garments: application to the  arm
8.14 Adjustable wrap compression system: application to the lower leg
8.15 Adjustable wrap compression system: application to the arm
8.16 Breathlessness management: using a handheld fan
8.17 Breathlessness management: essential oil administration via aroma stick inhaler
8.18 Supporting physical activity
8.19 Fatigue management
8.20 Relaxation and anxiety management
8.21 HME placement
8.22 Voice prosthesis: cleaning in situ
8.23 Nipple tattooing

Chapter 9

9.1 Last Offices

Acknowledgements

Based on the success of previous manuals, for the 9th edition in 2015, it was felt necessary to remove the chapters specific to cancer care in order to expand on the general procedures required in acute care.

At the same time, the number of procedures being undertaken by nurses in cancer care were increasing and we felt it was time to write and publish a complete manual devoted to the procedures required within cancer nursing.

As with previous manuals, the authors of each chapter were selected for their expertise and included are nurses and other allied healthcare professionals.

Some of the chapters, for example, Haematology and Cytotoxic therapy (now Systemic anticancer therapy) have been reviewed and updated, others are similar to those in the current 9th edition but have been edited to be more specific to cancer care. There are also a number of new chapters such as Acute oncology and Living with and beyond cancer.

We would like to thank all the lead authors and contributors to the chapters for their time and effort on this new publication. We would also like to thank other key people:

YiWen Hon and Neil Pearson, David Adams Library at the Royal Marsden School for their help and support of the authors searching and obtaining the necessary references to support the content.

Stephen Millward and the medical photography team for all the new photographs.

Our families and friends who continue to encourage us in this momentous task.

Finally our thanks go to Louise McNamara, Alison Nick, Aileen Castell and the staff of Wiley for their advice and support in all aspects of the publishing process.

Sara Lister
Lisa Dougherty

List of contributors

Kate Ashforth MSc Cert MRCSLT

Joint Head of Speech and Language Therapy

(Chapter 8: Living with and beyond cancer)

Janet Baker RN, BSc, MSc CNS/Lecturer Practitioner

Apheresis Nurse Specialist

(Chapter 2: Haematological procedures)

Sue Broom RN

Sister Day Surgery and Surgical Admissions

(Chapter 8: Living with and beyond cancer)

Louise Causer RN, Onc cert, MBA

Clinical Nurse Specialist for Radioisotope Therapy

(Chapter 1: Diagnostic investigations; Chapter 5: Radionuclide therapy)

Suzanne Chapman MSc, BSc, RN

Clinical Nurse Specialist, Pain Management

(Chapter 3: Cancer pain assessment and management)

Jill Cooper MSc

Head Occupational Therapist

(Chapter 8: Living with and beyond cancer)

Andrew Dimech RN, BN, MSc ICU, Dip Onc

Divisional Clinical Nurse Director, Clinical Services and Lead Cancer Nurse

(Chapter 1: Diagnostic investigations)

Dr Lisa Dougherty OBE, DClinP, RN, MSc

Independent Nurse Consultant (Intravenous Therapy)

(Chapter 4: Administration of systemic anticancer therapies)

Dr Natalie Doyle RN Dnurs MSc BSc

Nurse Consultant, Living with and beyond cancer

(Chapter 8: Living with and beyond cancer)

Andreia Fernandes RN, BSc, MSc

Clinical Nurse Specialist in Gynae Oncology

(Chapter 1: Diagnostic investigations)

Denise Flett RN, MSc, BSc, DepHE

Advanced Nurse Practitioner, Breast/Nursing Research Fellow

(Chapter 8: Living with and beyond cancer)

Alyson Foyle RN

Ward Sister

(Chapter 2: Haematological procedures)

Martin Galligan PGCert, BSc, RN

Clinical Nurse Specialist, Pain Management

(Chapter 3: Cancer pain assessment and management)

Jane Gauld BSc (Hons)

Macmillan Specialist Lymphoedema Practitioner

(Chapter 8: Living with and beyond cancer)

Ali Hodge Post Grad Dip Advanced Nurse Practitioner, MSc, PCGE, BSc (Hons)

Advanced Nurse Practitioner Acute Oncology

(Chapter 7: Acute oncology)

Nikki Holloway RN

Prostate and Testes Cancer Clinical Nurse Specialist

(Chapter 8: Living with and beyond cancer)

Sonja Hoy PGDip, BSc (Hons), RN

Clinical Nurse Specialist in Head, Neck, Thyroid Oncology and Radiation Protection

(Chapter 5: Radionuclide therapy)

Lorraine Hyde RN, Dip Nursing, ONC, BSc (Hons)

Matron-Lead Nurse Medical Day Units

(Chapter 4: Administration of systemic anticancer therapies)

Kate Jones Grad Dip Phys; MSc

Clinical Specialist Physiotherapist

(Chapter 8: Living with and beyond cancer)

Louisa Jones BA, BSc, RN, Dep HE

Ward Sister

(Chapter 2: Haematological procedures)

Netty Kinsella RN, BSc, MSc

Uro-Oncology Nurse Consultant

(Chapter 1: Diagnostic investigations)

Hayley Leonard BSc (Hons), Dip, RN

Anthony Nolan Post Transplant Clinical Nurse Specialist

(Chapter 6: Wound management)

Sara Lister MA, MSc, PGDAE, BSc (Hons), RN, Dip, Counselling, MBACP

Head of Pastoral Care and Psychological Support/Nurse Counsellor

(Chapter 8: Living with and beyond cancer)

Angela Little BSc, RN

Matron Drug Development Unit

(Chapter 4: Administration of systemic anticancer therapies)

Rebecca Martin MSc, BSc (Hons), RN, NIP

Advanced Nurse Practitioner – Urology

(Chapter 1: Diagnostic investigations)

Louise McNamara MSc, BN, RN

Assistant Editor

(Chapter 8: Living with and beyond cancer)

Jessica Pealing MPharm, PGDipGPP

Specialist Lung Cancer and Clinical Commissioning  Pharmacist

(Chapter 4: Administration of systemic anticancer therapies)

Justin Roe BA (Hons), PG Dip, MSc, PhD

Joint Head of Speech and Language Therapy

(Chapter 8: Living with and beyond cancer)

Cathy Sandsund MSc, Dip Grad Pys, MCSP

(Chapter 8: Living with and beyond cancer)

Dr Clare Shaw PhD RD

Consultant Dietitian

(Chapter 8: Living with and beyond cancer)

Nikki Snuggs RN, BSc (Hons)

Matron, Breast and Plastics CBU

(Chapter 1: Diagnostic investigations; Chapter 6: Wound management)

Dr Anna-Marie Stevens RN, DcP, MSC, BSc (Hons) onc cert

Nurse Consultant Palliative Care

(Chapter 3: Cancer pain assessment and management; Chapter 9: End of life care)

Samantha Wigfall MSc, BSc (Hons), Dep HE, RN, NIP

Matron/Lead Nurse Haematology

(Chapter 2: Haematological procedures)

Jennifer Wiggins MSc, GCRB registered

Senior Genetic Counsellor

(Chapter 1: Diagnostic investigations)

Mary Wilkins DCR (T)

Radiotherapy Superintendent

(Chapter 6: Wound management)

Pauline Doran Williams BSc, RN

Clinical Nurse Specialist Plastic Surgery

(Chapter 6: Wound management)

Lynn Worley BSc (Hons) RGN RMN

Clinical Nurse Specialist Plastic Surgery

(Chapter 6: Wound management)