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    ABC of Cancer Care
    ABC of Cancer Care
    ABC of Cancer Care
    Ebook388 pages2 hours

    ABC of Cancer Care

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    ABC of Cancer Care is a practical primary care guide to help health professionals better inform their patients, manage and recognize the common complications of cancers and their treatment, and understand the rationale and implications of decisions made in secondary and tertiary care.

     It provides coverage of the diagnosis, management, treatment and on-going surveillance of common cancers within the multidisciplinary context of primary care. Individual chapters assess the different treatment options, including surgery, radiotherapy and chemotherapy, and examine their possible side effects. The contribution of clinical trials and new advances in cancer treatment including biological and targeted therapies, robotic surgery and advanced radiotherapy techniques are all described. Other aspects of cancer care, from nursing support and nutrition to psychological care and survivorship, are also covered.

    Edited by a specialist and general practitioner team, with multidisciplinary contributors, ABC of Cancer Care is ideal for general practitioners, practice nurses, cancer care nurses, medical students, and all healthcare professionals treating and supporting cancer patients.

    This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.

     

     

     

     

    LanguageEnglish
    PublisherWiley
    Release dateMay 30, 2013
    ISBN9781118526859
    ABC of Cancer Care

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      Book preview

      ABC of Cancer Care - Carlo Palmieri

      Title PageTitle Page

      This edition first published 2013, © 2013 by John Wiley & Sons

      BMJ Books is an imprint of BMJ Publishing Group Limited, used under licence by Blackwell Publishing which was acquired by John Wiley & Sons in February 2007. Blackwell's publishing programme has been merged with Wiley's global Scientific, Technical and Medical business to form Wiley-Blackwell.

      Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

      Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK

      The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

      111 River Street, Hoboken, NJ 07030-5774, USA

      For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

      The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

      All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

      Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

      The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

      Library of Congress Cataloging-in-Publication Data

      ABC of cancer care / edited by Carlo Palmieri, Esther Bird, Richard Simcock.

      p. ; cm.

      Includes bibliographical references and index.

      ISBN 978-0-470-67440-6 (pbk.)

      I. Palmieri, Carlo, 1968– editor of compilation. II. Bird, Esther, 1970– editor of compilation. III. Simcock, Richard, 1969– editor of compilation.

      [DNLM: 1. Neoplasms—therapy. 2. Neoplasms—diagnosis. QZ 266]

      RC261.A7

      616.99′4—dc23

      2013008892

      A catalogue record for this book is available from the British Library.

      Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

      Cover Image used with permission from James Lewis, Clinical Media Centre, Brighton and Sussex University Hospitals NHS Trust. Copyright © 2013, James Lewis & Brighton and Sussex University Hospitals NHS Trust

      Cover design by Andy Meanden

      List of Contributors

      Mark Beresford DM MA BM Bch MRCP FRCR

      Consultant Clinical Oncologist & Visiting Senior Lecturer

      Royal United Hospital

      Bath, UK

      Esther Bird MA MRCP FRCR DFFP

      Silverdale GP Surgery

      Burgess Hill

      West Sussex, UK

      Ruth E. Board MBChB PhD

      Consultant in Medical Oncology

      Rosemere Cancer Centre

      Royal Preston Hospital

      Preston, UK

      Elizabeth Bowman

      Breast Clinical Nurse Specialist

      The Harley Street Clinic (HCA International)

      London, UK

      Timothy W.R. Briggs MD(Res) MCh(Orth) FRCS

      Consultant Orthopaedic Surgeon

      Royal National Orthopaedic Hospital

      Stanmore, UK

      Janet E. Brown MD FRCP

      Senior Clinical Lecturer & Honorary Consultant in Medical Oncology

      University of Leeds

      St James's University Hospital

      Leeds, UK

      Russell Burcombe MB BS BSc Hons MD FRCP FRCR

      Consultant Clinical Oncologist

      Kent Oncology Centre

      Maidstone Hospital

      Maidstone, Kent, UK

      Guy Burkill BSc MB BS MA MRCP FRCR

      Consultant Radiologist

      Brighton and Sussex University Hospitals NHS Trust

      Brighton, UK

      David Cameron MD FRCP

      Professor of Oncology

      University of Edinburgh

      Edinburgh, UK

      Sarah Cavilla

      Specialist Registrar in Clinical Oncology

      Sussex Cancer Centre

      Brighton and Sussex University Hospitals NHS Trust

      Brighton, UK

      Suzy Cleator BM BCh MRCP FRCR PhD

      Consultant Clinical Oncologist & Honorary Senior Lecturer

      Imperial College Healthcare NHS Trust

      London, UK

      Amelia Cook

      Breast Clinical Nurse Specialist

      The Harley Street Clinic (HCA International)

      London, UK

      Evandro de Azambuja MD PhD

      Medical Director

      BrEAST Data Centre

      Jules Bordet Institute

      Brussels, Belgium

      Mhairi Donald BSc RD

      Macmillan Consultant Dietician

      Sussex Cancer Centre

      Brighton and Sussex University Hospitals NHS Trust

      Brighton, UK

      Matthew Flook MRCP

      Specialist Registrar in Medical Oncology

      Department of Medical Oncology

      Imperial College Healthcare NHS Trust

      London, UK

      Duncan C. Gilbert MA MRCP FRCR PhD

      Consultant Clinical Oncologist & Honorary Clinical Senior Lecturer

      Sussex Cancer Centre

      Brighton and Sussex University Hospitals NHS Trust

      Brighton, UK

      Elizabeth J. Gillott BMedSci MBBS MRCS

      Research Fellow

      Royal National Orthopaedic Hospital

      Stanmore, UK

      Amy Guppy MD MRCP

      Consultant Medical Oncologist

      Mount Vernon Cancer Centre & Hillingdon Hospitals NHS Foundation Trust

      Northwood, Herts, UK

      Catherine Harper-Wynne MD FRCP

      Consultant Medical Oncologist

      Kent Oncology Centre

      Maidstone Hospital

      Barming, Kent, UK

      Jonathan Hicks

      Consultant Clinical Oncologist

      Beatson West of Scotland Cancer Centre

      Glasgow, UK

      Sacha Jon Howell MRCP PhD

      Senior Lecturer & Honorary Consultant in Medical Oncology

      University of Manchester, Institute of Cancer Studies

      Department of Medical Oncology

      The Christie NHS Foundation Trust

      Manchester, UK

      Colin R. James PhD MB BCH BAO MRCP

      Consultant & Honorary Senior Lecturer in Medical Oncology

      Belfast Health and Social Care Trust

      Department of Oncology

      Northern Ireland Cancer Centre

      Belfast City Hospital

      Belfast, UK

      Long R. Jiao MD FRCS

      Reader in Surgery

      Consultant Hepatobiliary & Pancreatic Surgeon

      Department of Surgery and Cancer

      Imperial College London

      London, UK

      Alison Jones MD FRCP

      Consultant Medical Oncologist

      Royal Free Hospital and University College Hospital

      London, UK

      Catherine M. Kelly MB BCh BAO BSc MSc MRCPI

      Consultant Medical Oncologist

      Department of Medical Oncology

      Mater Misericordiae University Hospital

      Dublin, Ireland

      Daniel Richard Leff MBBS PhD FRCS (Gen Surg)

      Cancer Research UK Academic Clinical Lecturer in Surgery

      Department of Surgery and Cancer

      Cancer Research UK Centre

      Imperial College London

      London, UK

      Adrian K.P. Lim MD FRCR

      Consultant Radiologist & Reader in Radiology

      Department of Imaging

      Imperial College Healthcare NHS Trust

      London, UK

      Beverley Longhurst

      Breast Clinical Nurse Specialist

      The Harley Street Clinic (HCA International)

      London, UK

      Thomas E. Newsom-Davis BSc PhD MRCP

      Consultant Medical Oncologist

      Chelsea and Westminster Healthcare NHS Foundation Trust

      London, UK

      Carlo Palmieri BSc PhD FRCP

      Professor of Translational Oncology & Consultant Medical Oncologist

      University of Liverpool

      Department of Molecular & Clinical Cancer Medicine

      The Royal Liverpool University Hospital & The Clatterbridge Cancer Centre

      Liverpool, UK

      Jennifer W. Pang BSc MB ChB

      Specialist Registrar in Clinical Oncology

      Imperial College Healthcare NHS Trust

      London, UK

      Alistair Ring MA MD MRCP

      Senior Lecturer & Honorary Consultant in Medical Oncology

      Brighton and Sussex Medical School

      Sussex Cancer Centre

      Brighton and Sussex University Hospitals NHS Trust

      Brighton, UK

      Mohammed Rizwanullah MRCP FRCR

      Consultant Clinical Oncologist

      Beatson West of Scotland Cancer Centre

      Glasgow, UK

      Jean Rodell

      Breast Clinical Nurse Specialist

      The Harley Street Clinic (HCA International)

      London, UK

      Richard Simcock MRCPI FRCR

      Consultant Clinical Oncologist

      Sussex Cancer Centre

      Brighton and Sussex University Hospitals NHS Trust

      Brighton, UK

      Clare Sullivan

      Breast Clinical Nurse Specialist

      The Harley Street Clinic (HCA International)

      London, UK

      Alastair Thomson BM PGCME MRCP FRCR

      Consultant Clinical Oncologist

      Royal Cornwall Hospital (Sunrise Centre)

      Truro, Cornwall, UK

      Lewis W. Thorne MB ChB FRCS(Neurosurgery)

      Consultant Neurosurgeon

      Victor Horsley Department of Neurosurgery

      The National Hospital for Neurology and Neurosurgery

      London, UK

      Juliet E. Wright MB BS MD FRCP

      Senior Lecturer & Honorary Consultant Elderly Medicine

      Brighton and Sussex Medical School

      Department of Elderly Medicine

      Brighton, UK

      Preface

      Every 2 minutes, someone in the UK is diagnosed with cancer. That amounts to over 300 000 cases per year and a lifetime risk of one in three for any given person. ‘Cancer’ however is a term which encompasses over 200 diseases, with differing presentations and biologies. Many of these cancer types are increasing in incidence. The average GP in England will see seven new cases of cancer per year and will have an increasing number of survivors under their care. For the NHS, providing care and treatment is hugely costly; £5 billion was spent in England in 2007/08, with 4.7 million bed days used by cancer patients annually.

      Although the number of cancers is steadily increasing, so too is the pace of innovation in treating the disease. The last decade has seen continued innovation in all areas of cancer care. The oldest form of cancer treatment, surgery, has been enriched by technological developments and advances in aftercare and rehabilitation. The physics-based specialty of radiation has benefited enormously from developments in computer processor power and chemotherapy has been enhanced not only by new agents but also by supportive drugs. Advances in our knowledge regarding cancer biology have enabled the development and introduction of so-called ‘targeted therapies’ and have set us on the road to a much more personalised approach to cancer treatment.

      Much of this innovation is driven by work in clinical trials and is only made possible by attentive care of the patient through advocacy, nursing and good-quality nutritional care, coordinated by multidisciplinary teams (MDTs). In addition, the contribution of charitable bodies, which fund research, support hospices and provide information and support to patients and their families, plays a key role.

      The end result of these innovations is that we have more cancer survivors than ever before and attention can now rightly turn to how these patients can rehabilitate and recover fully from their cancer experience; hence the emerging concept of cancer ‘survivorship’.

      Given the massive impact of this important disease, it is vital to be able to understand the basic principles underpinning the care of a cancer patient, as well as the myriad treatment options. We have produced this book to give the reader a clear idea of current treatment paradigms in modern cancer care. We have discussed principles, but also included sections outlining the common toxicities. Common emergencies and explanations of cancer care structure are included. Furthermore, we emphasise the importance of holistic care delivered in a multidisciplinary approach.

      The book has been written within the context of currently available treatments, both explaining their principles and with an eye to emerging possibilities. It is an exciting time to be involved in treating this disease, with more effective therapies in use than ever before, and we hope this book will prove a useful guide.

      Carlo Palmieri

      Esther Bird

      Richard Simcock

      Acknowledgements

      We would like to acknowledge the patients who agreed to be photographed or have their images used in this book, by doing so they have helped to ensure that this book is as user friendly, accessible and educational as possible. This book has them in mind, and we hope it will ensure a better understanding of cancer care by non-specialists and students, enabling all those who come into contact with cancer patients to be well informed and better placed to understand, help, guide, treat and support all those diagnosed with cancer.

      We thank all those who kindly agreed to become involved and gave up some of their precious free time to author chapters. The care of cancer is a multi-disciplinary approach and this book is a shining example of such team work. We are immensely grateful to Jon Peacock Senior Development Editor, for Health Sciences Books at Wiley-Blackwell for his support and guidance during the development and writing of this book. We also would like to thank Tim West, the Copy-Editor for the book and Neeta Roy, Project Manager at Laserwords and Natra Aziz, Assistant Production Editor at Wiley-Blackwell and their colleagues who help craft the various word documents, pictures and images into the final pages of print which you now see within these covers.

      Finally, we are grateful to our parents and families for their love and support as ever.

      Carlo Palmieri

      Esther Bird

      Richard Simcock

      Chapter 1

      Multidisciplinary Care

      Richard Simcock

      Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK

      OVERVIEW

      The multidisciplinary team (MDT) has become a vital part of the cancer patient's management

      The multidisciplinary team meeting (MDTM) should lead to improved decision making for the benefit of the patient

      Multidisciplinary teams will be constituted differently according to the cancer type

      Decisions on cancer treatment intent and modality depend on the cancer stage and patient performance status and fitness

      The MDTM allows for review of pathology and histology specimens in the diagnosis of the patient's cancer

      Cancer waiting time targets have increased the speed at which patients are treated for cancer in the UK

      Introduction

      Cancer care is complex. The first treatments were either palliation or surgery. During the twentieth century nonsurgical oncology grew exponentially to provide radiotherapy and chemotherapy. In this century we have begun to see an explosion in biological and targeted therapies, as well as technical developments in the delivery of surgery and radiation. This has been accompanied by parallel improvements in imaging and pathology, and an increasing recognition of the roles of advocacy, support and survivorship. In order to deliver best care for a cancer patient, it has become necessary to form teams to provide all the requisite expertise.

      Before the early 1990s, only a small proportion of cancer patients benefited from their care being managed by a team of cancer specialists, meaning that care was often not specialist and that staff worked in isolation. Data collection was poor, as was communication between primary and secondary care.

      In 1995, the Calman–Hine report recommended a reorganisation of cancer services such that whenever possible, cancer was managed by a multidisciplinary team (MDT). The MDT is defined in the Department of Health (DH)'s Manual for Cancer Services as the meeting of a group of

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