Sara Lister RN, PGDAE, BSc(Hons), MSC, MBACP, The Pastoral Care Centre, The Royal Marsden NHS Foundation Trust, UK.Lisa Dougherty OBE, RN, MSc, DClinP, Nurse Consultant Intravenous Therapy, The Royal Marsden NHS Foundation Trust, UK.Assistant Editor: Louise McNamara, B.Nursing; MSc in Advancing Professional Healthcare Practice, UK.

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• Foreword xiAcknowledgements xiiList of contributors xiiiList of abbreviations xvQuick reference to the procedure guidelines xviiHow to use your manual xixIntroduction xxi1 Diagnostic investigations 1Overview 2Diagnostic tests and investigations 2Tumour markers 4Cervical uterine smear 8Diagnostic radioisotope procedures (nuclear medicine) 12Transrectal ultrasound (TRUS) prostate biopsy 18Flexible cystoscopy 24Breast diagnostics 36Clinical breast examination 38Core biopsy 40Breast fine-needle aspiration (FNA) 43Breast punch biopsy 45Nipple discharge smear 47Genetic testing 48Websites 52References 52Procedure guidelines for Chapter 11.1 Cervical uterine smear using liquid-based cytology 91.2 Unsealed radioactive sources for diagnostic investigations 161.3 Transrectal ultrasound (TRUS) prostate biopsy 211.4 Flexible cystoscopy 271.5 Flexible cystoscopy with stent removal 301.6 Flexible cystoscopy with bladder biopsy 321.7 Flexible cystoscopy with argon plasma coagulation (APC)/cystodiathermy 351.8 Clinical breast examination 381.9 Core breast biopsy 411.10 Breast fine-needle aspiration (FNA) 431.11 Breast punch biopsy 451.12 Nipple discharge smear 472 Haematological procedures 57Overview 58Bone marrow procedures 58Aspiration and trephine biopsy 58Bone marrow harvest 67Apheresis 72Ribavirin administration 80Pentamidine isetionate administration 84Websites 87References 87Procedure guidelines for Chapter 22.1 Bone marrow aspiration and trephine biopsy 642.2 Bone marrow harvest 682.3 Apheresis 762.4 Ribavirin administration 822.5 Pentamidine isetionate administration 853 Cancer pain assessment and management 91Overview 92Cancer pain assessment and management 95Pain management 97Acupuncture 104Interventional techniques for managing complex cancer-related pain 107Single nerve blocks and injections 108Regional peripheral and plexus nerve blocks and infusions 108Neuraxial (spinal) blocks: epidural and intrathecal analgesia 109Entonox (nitrous oxide) administration 120References 125Procedure guidelines for Chapter 33.1 Acupuncture: preparation and administration 1063.2 Epidural/intrathecal sensory blockade: assessment 1143.3 Epidural/intrathecal exit site dressing change 1153.4 Epidural/intrathecal catheter removal 1153.5 Entonox administration 1234 Administration of systemic anticancer therapies 131Overview 132Systemic anticancer treatment 132Safe handling of hazardous drugs 133Administration of cytotoxic medications by nurses 137Intravenous administration of systemic anticancer therapy 138Extravasation 142Oral administration of systemic anticancer therapy 156Intramuscular and subcutaneous administration of cytotoxic drugs 162Topical application of cytotoxic drugs 164Intrathecal administration of cytotoxic drugs 165Intrapleural instillation of cytotoxic drugs 168Intravesical instillation of cytotoxic drugs 169Intraperitoneal instillation of cytotoxic drugs 172Intra-arterial administration of cytotoxic drugs 173Side-effects of chemotherapy 175Haematological side-effects 176Fatigue 176Gastrointestinal side-effects 176Adverse drug reactions 177Neurotoxicity 177Mucositis/stomatitis 177Nephrotoxicity/haemorrhagic cystitis 178Cardiotoxicity 178Pulmonary toxicity 178Hepatotoxicity 178Skin toxicities 178Alopecia 178Clinical research 184References 193Procedure guidelines for Chapter 44.1 Cytotoxic spillage management 1354.2 Cytotoxic therapy: intravenous administration of cytotoxic drugs 1414.3 Extravasation management: peripheral cannula 1504.4 Extravasation: performing flush-out following an extravasation 1524.5 Cytotoxic therapy: education for patients on oral cytotoxic drugs 1614.6 Cytotoxic therapy: intramuscular administration of cytotoxic drugs (Z-track) 1634.7 Cytotoxic therapy: topical application of cytotoxic drugs 1644.8 Cytotoxic therapy: intraventricular administration of cytotoxic drugs via an intraventricular access device (Ommaya reservoir) 1664.9 Cytotoxic therapy: intrapleural instillation of cytotoxic drugs 1684.10 Cytotoxic therapy: intravesical instillation of cytotoxic drugs 1704.11 Cytotoxic therapy: intraperitoneal instillation of cytotoxic drugs 1724.12 Intra-arterial administration of cytotoxic drugs 1744.13 Scalp cooling 1825 Radionuclide therapy 201Overview 202Radiation 202Radiation protection 202Unsealed source therapy 207Sealed source therapy 211Sealed source iodine-125 seeds used in prostate malignancies 220Intraoral sealed sources 220Websites 223References 223Procedure guidelines for Chapter 55.1 Radiation protection: major spillage of radioactive body fluids through incontinence and/or vomiting 2045.2 Radiation protection: contamination of bare hands by radioactive body fluids 2055.3 Radiation protection: death of a patient who has received unsealed radioactive source therapy 2055.4 Radiation protection: cardiac arrest of a patient who has received unsealed radioactive source therapy 2055.5 Radiation protection: evacuation due to fire of patients who have received unsealed radioactive source therapy 2065.6 Unsealed source therapy: entering and leaving the room of a patient who has received an unsealed radioactive source 2085.7 Unsealed source therapy: iodine-131 (oral capsule/liquid): administration 2095.8 Unsealed source therapy: iodine-131 mIBG treatment: patient care 2095.9 Sealed source therapy: caesium sources (manual or afterloading): patient care 2165.10 Sealed source therapy: low dose-rate Selectron treatment 2175.11 Sealed source therapy: Selectron applicator removal 2185.12 Sealed source therapy: insertion of sealed radioactive sources into the oral cavity 2216 Wound management 227Overview 228Malignant fungating wounds 228Wound assessment 230Treatment options 232Principles of the management of dressings for a malignant fungating wound 235Local wound management 235Graft-versus-host disease wounds 244Definition 244Skin care following radiotherapy 245Websites and useful addresses 249References 249Procedure guidelines for Chapter 66.1 Assessing a malignant fungating wound 2316.2 Dressing a malignant fungating wound 2437 Acute oncology 253Overview 254Haematological emergencies 255Central venous access device complications 255Thrombosis (catheter related) 259Sepsis 260Major artery rupture 261Superior vena cava obstruction 262Metabolic emergencies 264Hypercalcaemia of malignancy 264Hypomagnesaemia 267Side-effects from chemotherapy agents 268Diarrhoea (chemotherapy and radiotherapy induced) 268Nausea and vomiting 271Neutropenic sepsis 277Pneumonitis 280Structural 281Ascites (malignant) 281Bowel obstruction (malignant) 287Metastatic spinal cord compression 289Pericardial effusion (malignant) 301Raised intracranial pressure due to malignant disease 302References 303Procedure guidelines for Chapter 77.1 Carotid artery rupture (CAR) 2627.2 Abdominal paracentesis 2847.3 Log rolling for suspected/confirmed cervical spinal instability 2927.4 Positioning for suspected/confirmed cervical spinal instability: pelvic twist to right 2957.5 Log rolling for suspected/confirmed thoracolumbar spinal instability 2977.6 Early mobilization of the patient in bed 2988 Living with and beyond cancer 311Overview 312Section 8.1 Introduction 312The experience of living with or beyond cancer 312Section 8.2 Welfare advice 315Overview 315Websites 326Useful addresses 326Section 8.3 Supporting individuals with sexual concerns as a consequence of cancer 326Women’s sexual concerns following cancer 329Interventions 331Men’s sexual concerns following cancer 332Interventions 333Websites 334Section 8.4 Nutritional status 334Websites 339Section 8.5 Compression therapy in the management of lymphoedema 339Lymphoedema 339Assessment of the patient with lymphoedema and calculation of limb volume 341Compression bandaging 348Compression garments 357Adjustable wrap compression systems 361Websites 365Section 8.6 Non-pharmacological management of breathlessness 366Non-pharmacological support 367Websites 371Section 8.7 Physical activity for people with cancer 371Websites 377Section 8.8 Cancer-related fatigue and sleep 377Cancer-related fatigue 377Sleep 380Section 8.9 Communication for a patient with a laryngectomy 383Websites and useful addresses 389Section 8.10 Nipple tattooing 390References 396Procedure guidelines for Chapter 88.1 Conducting a holistic needs assessment (HNA) 3148.1a Developing and actioning a care plan 3158.1b Closure and follow-up 3158.2 How a patient should make a claim for Personal Independence Payment 3228.3 How a patient should make a claim for Attendance Allowance 3238.4 How a patient should make a claim for Carer’s Allowance 3248.5 How a patient should make a claim for Employment and Support Allowance 3258.6 Assessing a patient’s sexual health concerns 3278.7 Measuring the weight, height and waist circumference of the patient 3368.8 Compression therapy limb volume calculation: lower limb 3468.9 Compression therapy limb volume calculation: upper limb 3468.10 Compression bandaging (multilayer short-stretch): bandaging arm and the fingers 3508.11 Compression bandaging (multilayer short-stretch): bandaging a leg and the toes 3548.12 Elastic compression garments: application to the leg 3598.13 Elastic compression garments: application to the arm 3608.14 Adjustable wrap compression system: application to the lower leg 3638.15 Adjustable wrap compression system: application to the arm 3648.16 Breathlessness management: using a handheld fan 3688.17 Breathlessness management: essential oil administration via aroma stick inhaler 3708.18 Supporting physical activity 3758.19 Fatigue management 3788.20 Relaxation and anxiety management 3828.21 HME placement 3878.22 Voice prosthesis: cleaning in situ 3888.23 Nipple tattooing 3949 End of life care 403Overview 404Last Offices 408Websites and useful addresses 416Online resources 416References 416Procedure guideline for Chapter 99.1 Last Offices 411Index 419

Sara Lister RN, PGDAE, BSc(Hons), MSC, MBACP, The Pastoral Care Centre, The Royal Marsden NHS Foundation Trust, UK.Lisa Dougherty OBE, RN, MSc, DClinP, Nurse Consultant Intravenous Therapy, The Royal Marsden NHS Foundation Trust, UK.Assistant Editor: Louise McNamara, B.Nursing; MSc in Advancing Professional Healthcare Practice, UK.

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• Foreword xiAcknowledgements xiiList of contributors xiiiList of abbreviations xvQuick reference to the procedure guidelines xviiHow to use your manual xixIntroduction xxi1 Diagnostic investigations 1Overview 2Diagnostic tests and investigations 2Tumour markers 4Cervical uterine smear 8Diagnostic radioisotope procedures (nuclear medicine) 12Transrectal ultrasound (TRUS) prostate biopsy 18Flexible cystoscopy 24Breast diagnostics 36Clinical breast examination 38Core biopsy 40Breast fine-needle aspiration (FNA) 43Breast punch biopsy 45Nipple discharge smear 47Genetic testing 48Websites 52References 52Procedure guidelines for Chapter 11.1 Cervical uterine smear using liquid-based cytology 91.2 Unsealed radioactive sources for diagnostic investigations 161.3 Transrectal ultrasound (TRUS) prostate biopsy 211.4 Flexible cystoscopy 271.5 Flexible cystoscopy with stent removal 301.6 Flexible cystoscopy with bladder biopsy 321.7 Flexible cystoscopy with argon plasma coagulation (APC)/cystodiathermy 351.8 Clinical breast examination 381.9 Core breast biopsy 411.10 Breast fine-needle aspiration (FNA) 431.11 Breast punch biopsy 451.12 Nipple discharge smear 472 Haematological procedures 57Overview 58Bone marrow procedures 58Aspiration and trephine biopsy 58Bone marrow harvest 67Apheresis 72Ribavirin administration 80Pentamidine isetionate administration 84Websites 87References 87Procedure guidelines for Chapter 22.1 Bone marrow aspiration and trephine biopsy 642.2 Bone marrow harvest 682.3 Apheresis 762.4 Ribavirin administration 822.5 Pentamidine isetionate administration 853 Cancer pain assessment and management 91Overview 92Cancer pain assessment and management 95Pain management 97Acupuncture 104Interventional techniques for managing complex cancer-related pain 107Single nerve blocks and injections 108Regional peripheral and plexus nerve blocks and infusions 108Neuraxial (spinal) blocks: epidural and intrathecal analgesia 109Entonox (nitrous oxide) administration 120References 125Procedure guidelines for Chapter 33.1 Acupuncture: preparation and administration 1063.2 Epidural/intrathecal sensory blockade: assessment 1143.3 Epidural/intrathecal exit site dressing change 1153.4 Epidural/intrathecal catheter removal 1153.5 Entonox administration 1234 Administration of systemic anticancer therapies 131Overview 132Systemic anticancer treatment 132Safe handling of hazardous drugs 133Administration of cytotoxic medications by nurses 137Intravenous administration of systemic anticancer therapy 138Extravasation 142Oral administration of systemic anticancer therapy 156Intramuscular and subcutaneous administration of cytotoxic drugs 162Topical application of cytotoxic drugs 164Intrathecal administration of cytotoxic drugs 165Intrapleural instillation of cytotoxic drugs 168Intravesical instillation of cytotoxic drugs 169Intraperitoneal instillation of cytotoxic drugs 172Intra-arterial administration of cytotoxic drugs 173Side-effects of chemotherapy 175Haematological side-effects 176Fatigue 176Gastrointestinal side-effects 176Adverse drug reactions 177Neurotoxicity 177Mucositis/stomatitis 177Nephrotoxicity/haemorrhagic cystitis 178Cardiotoxicity 178Pulmonary toxicity 178Hepatotoxicity 178Skin toxicities 178Alopecia 178Clinical research 184References 193Procedure guidelines for Chapter 44.1 Cytotoxic spillage management 1354.2 Cytotoxic therapy: intravenous administration of cytotoxic drugs 1414.3 Extravasation management: peripheral cannula 1504.4 Extravasation: performing flush-out following an extravasation 1524.5 Cytotoxic therapy: education for patients on oral cytotoxic drugs 1614.6 Cytotoxic therapy: intramuscular administration of cytotoxic drugs (Z-track) 1634.7 Cytotoxic therapy: topical application of cytotoxic drugs 1644.8 Cytotoxic therapy: intraventricular administration of cytotoxic drugs via an intraventricular access device (Ommaya reservoir) 1664.9 Cytotoxic therapy: intrapleural instillation of cytotoxic drugs 1684.10 Cytotoxic therapy: intravesical instillation of cytotoxic drugs 1704.11 Cytotoxic therapy: intraperitoneal instillation of cytotoxic drugs 1724.12 Intra-arterial administration of cytotoxic drugs 1744.13 Scalp cooling 1825 Radionuclide therapy 201Overview 202Radiation 202Radiation protection 202Unsealed source therapy 207Sealed source therapy 211Sealed source iodine-125 seeds used in prostate malignancies 220Intraoral sealed sources 220Websites 223References 223Procedure guidelines for Chapter 55.1 Radiation protection: major spillage of radioactive body fluids through incontinence and/or vomiting 2045.2 Radiation protection: contamination of bare hands by radioactive body fluids 2055.3 Radiation protection: death of a patient who has received unsealed radioactive source therapy 2055.4 Radiation protection: cardiac arrest of a patient who has received unsealed radioactive source therapy 2055.5 Radiation protection: evacuation due to fire of patients who have received unsealed radioactive source therapy 2065.6 Unsealed source therapy: entering and leaving the room of a patient who has received an unsealed radioactive source 2085.7 Unsealed source therapy: iodine-131 (oral capsule/liquid): administration 2095.8 Unsealed source therapy: iodine-131 mIBG treatment: patient care 2095.9 Sealed source therapy: caesium sources (manual or afterloading): patient care 2165.10 Sealed source therapy: low dose-rate Selectron treatment 2175.11 Sealed source therapy: Selectron applicator removal 2185.12 Sealed source therapy: insertion of sealed radioactive sources into the oral cavity 2216 Wound management 227Overview 228Malignant fungating wounds 228Wound assessment 230Treatment options 232Principles of the management of dressings for a malignant fungating wound 235Local wound management 235Graft-versus-host disease wounds 244Definition 244Skin care following radiotherapy 245Websites and useful addresses 249References 249Procedure guidelines for Chapter 66.1 Assessing a malignant fungating wound 2316.2 Dressing a malignant fungating wound 2437 Acute oncology 253Overview 254Haematological emergencies 255Central venous access device complications 255Thrombosis (catheter related) 259Sepsis 260Major artery rupture 261Superior vena cava obstruction 262Metabolic emergencies 264Hypercalcaemia of malignancy 264Hypomagnesaemia 267Side-effects from chemotherapy agents 268Diarrhoea (chemotherapy and radiotherapy induced) 268Nausea and vomiting 271Neutropenic sepsis 277Pneumonitis 280Structural 281Ascites (malignant) 281Bowel obstruction (malignant) 287Metastatic spinal cord compression 289Pericardial effusion (malignant) 301Raised intracranial pressure due to malignant disease 302References 303Procedure guidelines for Chapter 77.1 Carotid artery rupture (CAR) 2627.2 Abdominal paracentesis 2847.3 Log rolling for suspected/confirmed cervical spinal instability 2927.4 Positioning for suspected/confirmed cervical spinal instability: pelvic twist to right 2957.5 Log rolling for suspected/confirmed thoracolumbar spinal instability 2977.6 Early mobilization of the patient in bed 2988 Living with and beyond cancer 311Overview 312Section 8.1 Introduction 312The experience of living with or beyond cancer 312Section 8.2 Welfare advice 315Overview 315Websites 326Useful addresses 326Section 8.3 Supporting individuals with sexual concerns as a consequence of cancer 326Women’s sexual concerns following cancer 329Interventions 331Men’s sexual concerns following cancer 332Interventions 333Websites 334Section 8.4 Nutritional status 334Websites 339Section 8.5 Compression therapy in the management of lymphoedema 339Lymphoedema 339Assessment of the patient with lymphoedema and calculation of limb volume 341Compression bandaging 348Compression garments 357Adjustable wrap compression systems 361Websites 365Section 8.6 Non-pharmacological management of breathlessness 366Non-pharmacological support 367Websites 371Section 8.7 Physical activity for people with cancer 371Websites 377Section 8.8 Cancer-related fatigue and sleep 377Cancer-related fatigue 377Sleep 380Section 8.9 Communication for a patient with a laryngectomy 383Websites and useful addresses 389Section 8.10 Nipple tattooing 390References 396Procedure guidelines for Chapter 88.1 Conducting a holistic needs assessment (HNA) 3148.1a Developing and actioning a care plan 3158.1b Closure and follow-up 3158.2 How a patient should make a claim for Personal Independence Payment 3228.3 How a patient should make a claim for Attendance Allowance 3238.4 How a patient should make a claim for Carer’s Allowance 3248.5 How a patient should make a claim for Employment and Support Allowance 3258.6 Assessing a patient’s sexual health concerns 3278.7 Measuring the weight, height and waist circumference of the patient 3368.8 Compression therapy limb volume calculation: lower limb 3468.9 Compression therapy limb volume calculation: upper limb 3468.10 Compression bandaging (multilayer short-stretch): bandaging arm and the fingers 3508.11 Compression bandaging (multilayer short-stretch): bandaging a leg and the toes 3548.12 Elastic compression garments: application to the leg 3598.13 Elastic compression garments: application to the arm 3608.14 Adjustable wrap compression system: application to the lower leg 3638.15 Adjustable wrap compression system: application to the arm 3648.16 Breathlessness management: using a handheld fan 3688.17 Breathlessness management: essential oil administration via aroma stick inhaler 3708.18 Supporting physical activity 3758.19 Fatigue management 3788.20 Relaxation and anxiety management 3828.21 HME placement 3878.22 Voice prosthesis: cleaning in situ 3888.23 Nipple tattooing 3949 End of life care 403Overview 404Last Offices 408Websites and useful addresses 416Online resources 416References 416Procedure guideline for Chapter 99.1 Last Offices 411Index 419