19 March 2020
26 March 2020 Update
As Oncology Nurses across the UK continue to respond to the COVID-19 pandemic and the accompanying massive changes to the way in which oncology services are delivered. UKONS and Macmillan Cancer Support are moving to weekly Breaking News updates on resources which might help our membership (in fact all cancer nurses) to cope with these huge pressures.
1. Rapid NICE Guidance
The NHS Guidance on Oncology patients and COVID-19 which was produced last week https://www.england.nhs.uk/coronavirus/publication/specialty-guides-cancer/ has now ben supplemented by the ‘COVID-19 rapid guideline: delivery of systemic anticancer treatments’. This is an important document which re-iterates the previous document but outlines the procedure for prioritisation of SACT and defines the national prioritisation categories for SACT. The document also outlines other good practice, defines the role of MDT working in SACT prioritisation and stresses the importance of communication with patients with regard to this. UKONS was consulted and contributed to this advice and it is available here: https://www.nice.org.uk/guidance/ng161
2. Palliative Care and COVID
Here are some resource links for palliative care that the Association of Palliative Care have collated. If you are looking for resources to support your palliative care response to COVID-19, the APC has collated useful resources online for you. This is not an exhaustive list but is selected for important and reliable sources. They have put the UK resources first, and the NICE guidance (see above) is particularly important. International resources are also useful but may be less directly relevant to the UK situation and any medication references will differ of course. https://docs.google.com/document/d/1HR1ulUBbCjlITkuB-sUQJZ90yx9l2v3N_JUqPMm7qpw/mobilebasic
3. Managing Clinical Trials During Coronavirus Pandemic
The Medicines and Healthcare Products Regulatory Agency (MHRA) is adopting as flexible and pragmatic an approach as possible with regard to regulatory requirements for clinical trials during this time. They have recognised that clinical trial resource may be absent or redeployed from research activities and regulatory affairs towards front-line care. Their first priority is the safety of trial participants. This guidance will be updated as the situation changes over time and contains information on pausing clinical trials..https://www.gov.uk/guidance/managing-clinical-trials-during-coronavirus-covid-19
4. Pre-chemotherapy Clinics
Omitting all non-essential hospital visits is a sound principle which has resulted in many hospitals utilising telephone or video-conferenced clinics instead. Specialist cancer nurses are already involved in these clinics and the discussion and outcomes need to be captured and documented accurately.
5. Pre-treatment Consultations
It is important that we continue to support and educate patients starting treatment to manage their side effects and to report symptoms appropriately to acute oncology services. Pre-treatment consultations can be conducted by telephone or via video link. UKONS have produced a film to support patients and explain the contents of the CRUK ‘Your Cancer Treatment Record to accompany these consultations. This film can be accessed here https://www.youtube.com/watch?v=16ZIZ3Il6UI&feature=youtu.be
6. Managing Your Mental Health During the Pandemic
The Mental Health Foundation has produced some excellent guidance on how to safeguard your mental health in these trying circumstances. There are some great tips here. https://www.mentalhealth.org.uk/publications/looking-after-your-mental-health-during-coronavirus-outbreak
Macmillan Cancer Support have also produced a list of resources:
NHS are recommending Every Mind Matters https://www.nhs.uk/oneyou/every-mind-matters/top-tips-to-improve-your-mental-wellbeing/8.
7. COVID-19 and Pregnancy
Royal College of Obstetricians and Gynaecologists (RCOG) advice. The RCOG has released advice on this issue. The resource provides guidance for healthcare professionals working with pregnant women but also gives Occupational health advice for employers and pregnant women during the COVID-19 pandemic. https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-21-covid19-pregnancy-guidance-23.pdf
8. Advice for Patients on a ‘Grab Bag’ if hospitalised during current crisis.
Following a very recent admission to hospital one of our board members has produced the following list for our patients who might find themselves admitted during the current situation. Prepare a ‘Grab Bag’ of essential items in case you need to go into hospital. Make sure you take disposal items with you if you have them. Take
- Usual Medication
- Tissues – if you have suspected COVID-19 you may not be able to leave the bed-space and it is wise to have a supply of tissue and toilet roll for your own use.
- Bottles of water. Bring these for your own use as hospitals may not have and endless disposable cups. Sparking water is refreshing as any oxygen really dries the mouth.
- Lip-Balm – lips can dry in hospital. Nebulisers and oxygen can make the situation worse.
- Disposable toothbrush and toothpaste
- Disposable Washlets – to wipe hands and face and freshen up if needed. Staff are likely to be very busy
- Mobile phone and charger – will be only way to keep in touch with family
- Pen and Paper – for important information you do not want to forget
- Loose fitting night clothes – two sets will be enough. You may not be able to change as often as you would do normally. Hospitals can also provide gowns and other items.
- Plastic bags – two small bags for your rubbish, two larger bags to double bag laundry
Don’t bother taking a towel and best to take disposable slippers that you can discard at the end of the stay.
It is likely, and desirable that you should try and leave hospital as soon as it is safe to get home. Staff will give you advice on this.
9. The Macmillan ‘Cancer and Coronavirus’ page has lots of links and is continuously updated. Macmillan have reconfigured a new page and they will begin to add more tools and resources that professionals can signpost people to. At the moment there are only 4 “tiles” but more are going up today. It means people can access all they need via one link rather than just the coronavirus info. Some physical activity videos are also in place. Available here https://www.macmillan.org.uk/coronavirus
10. Royal College of Radiologists have published advice on radiotherapy and have now supplemented this by giving advice on imaging in the current pandemic. This is available here https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/coronavirus-covid-19-resources/coronavirus-covid-19
19 March 2020
All UK Oncology Nurses are currently involved with trying to keep patients safe as they can be from the COVID-19 illness caused by the novel coronavirus. Oncology patients have been recognised for some time as being an ‘at risk’ group and now we are in the position of trying to take steps to protect them. This ‘Top Story’ will take the form of a number of links and resources to try and help us do that. We have worked with Macmillan Cancer Support to collate these resources but there is new material appearing all the time. The most important of these will be circulated by email to try and ensure we keep you as informed as possible
- Current NHS Guidance on Oncology patients and COVID-19. The latest document to be released is entitled ‘Clinical guide for the management of cancer patients during the coronavirus pandemic’ and is available here https://www.england.nhs.uk/coronavirus/publication/specialty-guides-cancer/
This lays out the principles of prioritising oncology patients for surgical, SACT and radiation therapy and also provides some general principles of managing oncology patients during the pandemic. This document will be accompanied in the next few days by further advice on specific prioritisation of oncology patients receiving SACT. As soon as we have this, we will circulate it. This advice may well result in some patients being advised against coming into hospital for treatment if the benefits from the treatment are outweighed by the risks
- Radiotherapy and COVID-19 – a summary of the thinking of the Royal College of Radiologists is to be found here https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/rcr-position-coronavirus-covid-19-clinical-oncology There is a recognition that ‘clinicians may need to depart from established treatment pathways and protocols’ and the process for considering this as a multi-disciplinary team. Many of the measures are based on the need to try and reduce attendance in the radiotherapy department. An example of this might be the reduction of attendance for patients undergoing breast radiotherapy using the results of the FASTFORWARD trial. This has already been adopted by some radiotherapy centres. This should be discussed with breast clinical oncologists to gain their opinion of feasibility. Other similar measures may well be adopted, and patients will need to be kept informed of the rationale for these changes.
- Reducing attendance at hospital for oncology patients. This is a sound principle which has resulted in many hospitals reducing non-essential visits to the hospital and utilising telephone or video-conferenced clinics instead. Patients should be informed that this is likely to happen. Inevitably specialist cancer nurses will be involved in these clinics and these need to be captured and documented accurately. In terms of the work of oncology nurses, Pre-Chemotherapy Clinics are generally designated as important but not essential. Much of this work can be done over the telephone or via video link. UKONS have produced a film to support patients and explain the contents of the CRUK ‘Your Cancer Treatment Record to accompany these clinics.
- Acute Oncology Services – many of these services will now find themselves in the front-line of dealing with unwell oncology patients coming into hospitals. It is important that patients on chemotherapy continue to utilise the UKONS Triage lines and do not take the general advice to self-isolate if they develop symptoms. It is a good principle to try and separate oncology patients from other group and are subjected to specialist assessment when they attend the hospital, but we recognise that this may be logistically difficult in terms of space and specialist staffing. It is also important patients may still develop Neutropaenic Sepsis and need to be treated within 1 hour with intravenous antibiotics. The symptoms of neutropaenic sepsis and COVID-19 may appear similar in the first instance and there is a risk that oncology patients with neutropaenic sepsis may be treated as COVID-19, and vice versa.
- Staff Redeployment and re-training. It is likely that there are groups of oncology nurses that may need to deploy into areas to administer chemotherapy/SACT. It takes three months to train a SACT nurse. Instead, consider retraining nurses who have moved to other cancer nursing specialist roles. The process can be supported by the UK Oncology Nursing Society (UKONS) SACT Competency Passport. This includes theoretical and clinical practice assessment components Nurses identified for retraining should:
• Have administered SACT within the previous 2 years
• Evidence completion of theoretical training (e.g. the passport or accredited course)
• Complete the relevant passport clinical competencies with a practice assessor.
Retraining can be supported though local clinical/practical refreshers e.g. cannulation and UKONS tools available from https://www.ukons.org/. This includes the passport and free on-line e-learning films https://www.ukons.org/events/free-online-sact-learning-resource/
- Social distancing – Patients receiving chemotherapy have been encouraged to reduce the social contact they have with others. A ‘traffic light system’ has been developed by a Macmillan GP that might be useful for patients https://twitter.com/dreliselang/status/1239846607199383554?s=12
In addition the Government advice re social distancing can be found here https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults?fbclid=IwAR2JcGxozkQ4zcvsMYcjmBY3WIHsYy-HS_cYwMWvQu7sFDaOc92HyCLbTDY
- A really good summary website can be found here as it collates lots of information for primary care and also is very good at bringing together information and guidance from all of the four nations. https://primarycarepathways.co.uk/covid2019
- This link is online training modules in a number of areas in different languages at the bottom but we have pulled out the link to the WHO training on preparedness for COVID. https://openwho.org/channels/covid-19
- There is some interesting information and discussion about face masks and a discussions about protection equipment has been raised for community delivery of EOL care that is being looked at nationally as there is a shortage of this https://www.theguardian.com/world/2020/mar/17/face-mask-coronavirus-covid-19-facts-
All that remains is for UKONS and Macmillan to thank Oncology Nurses for continuing to work selflessly to protect our patients during this demanding time. We will try and circulate any information we can to help you in your work.