Acute Oncology Initial Management Guidelines - Version 3.0


Guidelines for the initial management of adult patients who have a cancer diagnosis, and present as an emergency or unplanned admission with a complication of their disease or cancer treatment.




Tutorial


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Introduction


These guidelines relate to the initial assessment and immediate management of Acute Oncology patients, i.e. patients presenting with an acute problem, demonstrating symptoms deemed as having been caused by:

  • Systemic Anti-Cancer Therapy (SACT),
  • Radiotherapy,
  • Malignant disease,
  • A previously undiagnosed cancer where an urgent oncology/haematology assessment is required.

It is emphasised that these guidelines focus on initial assessment at presentation and management for the first 24 hours. Patients should be referred to, or discussed with the Acute Oncology Team as soon as possible following presentation. The Acute Oncology team will provide further advice and on-going management guidance.

To aid in this urgent initial assessment, each protocol follows a RAG (Red, Amber, Green) format and quick reference assessment, which is in line with the UKONS Oncology/Haematology 24-Hour Triage Tool (V2, 2016):

https://www.ukons.org/site/assets/files/1134/triage_tool_poster.pdf

The Common Terminology Criteria for Adverse Events (CTCAE Version 4.3), an international standard set of criteria for defining adverse events (AE) and their grading within clinical trials and the routine management of Oncology/Haematology patients, has been applied to assist with the recognition and management of AE:

http://www.hrc.govt.nz/sites/default/files/CTCAE%20manual%20-%20DMCC.pdf

Intended Audience

These guidelines are intended for use by all health care professionals who assess and/or manage acute oncology patients at presentation. The guidelines may also be useful as an adjunct to the UKONS Triage tool when providing care advice following telephone triage Appendix Page.

They are mostly single-page "see-and-treat" guides. Whilst drug names may be referenced within each protocol, this is offered as a guide only; it is acknowledged that local variation may apply.

Please be aware of NICE National Guidelines/ Pathways for the management of:

The development and consultation group worked to provide a set of generic guidelines based on national guidance and clinical expertise. They have now been reviewed and updated to ensure that they remain applicable and cover current best practice in the management of treatment induced toxicity and acute disease related complications.

The authors request that the original source is acknowledged in all copies or adaptations.


Disclaimer


These Guidelines are for the use of medical professionals only. They are not intended for public use, including by oncology patients. UKONS does not permit the creation of derivative works, unless they are authorised.

The information contained in these guidelines is a consensus of the development and consultation groups' views on current treatment. They should be used in conjunction with any local policies/ procedures/ guidelines and should be approved for use according to the trust clinical governance process. Care has been taken in the preparation of the information contained in the guidelines. Nevertheless, any person seeking to consult the guideline, apply its recommendations or use its content is expected to use independent, personal medical and/or clinical judgment in the context of the individual clinical circumstances, or to seek out the supervision of a qualified clinician. The United Kingdom Oncology Nursing Society makes no representation or guarantee of any kind whatsoever regarding the guidelines content or its use or application and disclaim any responsibility for its use or application in any way.

The development of this App has been supported by grants from Bristol Myers Squibb (BMS) and Roche Products Limited. BMS and Roche Products Limited has had no control over the content of this App.


The following professional bodies have reviewed the guidelines and support use in practice: