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Oncology

Paige-Hearn-and-MumGoing home during treatment can be a worrying time for our patients and their families. To make things a bit easier, our staff will provide lots of information to prepare you for the big day.

They will also contact community nurses and other healthcare professionals to ensure you are supported at home. Details will also be provided of whom you may need to contact in the Shared Care Centre. Our patients will return to hospital regularly for further treatment or for check ups, either as an inpatient or as an outpatient to clinic or Day Care.

Please be sure you are clear about your next visit before you leave.

Taking Temperatures

Please ensure that you have a centigrade thermometer at home. Usually small digital thermometers are easy to use and can be placed safely under the armpit. These thermometers are available from our Unit but some families do prefer to buy their own aural (ear) thermometer. If you choose to do this, please bring it to our Unit so that we can check you know how to use it and that it is working correctly.

Patients who complain of being hot or unwell must have their temperature checked immediately. A high temperature may be a sign of infection. Since chemotherapy drugs will have reduced the ability to fight infections, it is important to respond quickly to high temperatures. Antibiotic treatment in hospital may be needed.

If a patient has a temperature of 38°C-38.4°C, their temperature should be retaken an hour later. If the temperature remains the same or is higher, please telephone the Unit (or the local Shared Care Centre) to be admitted immediately. It is very important to contact our Unit so please don’t think you are making a fuss – even when there are no obvious differences in appearance.

Vomiting

Some patients may feel sick and vomit for several days after chemotherapy has finished. It may be necessary in such cases to continue taking anti sickness medicines at home. If vomiting continues at home and patients are unable to keep down fluids or if urine is not passed within 12 hours, please contact the Unit or the Shared Care Centre. Patients must not take paracetamol, Calpol, Disprol or Calprofen as these can hide temperatures. Calprofen also contains Ibuprofen which can lower platelets.

Medication

Medication may need to be taken at home. Please make sure that you understand all the relevant information e.g. correct dosage, the time of day and number of days it should be taken. Instructions will be put on the labels of any medication containers that we give to you. Please check whether the medicine needs to be kept in the fridge or in a cupboard at room temperature. All medicines should be kept out of the reach of children, preferably in a locked cupboard. If you have any questions about medicines, please telephone the Unit or Shared Care Centre. It is very important that the course of prescribed medicine is given correctly.

Oral Hygiene

Oral health can be affected by treatment so it is necessary that our patients and their families understand the importance of caring for the mouth and teeth.

Dental Hygiene

Regular brushing of the teeth helps to prevent inflammation of the gums (gingivitis), infection and tooth decay. Therefore it is really important that our patients (and their families) brush and clean their mouth effectively.

Equipment and Care

Toothbrush

• Patients must have a toothbrush with a small, soft nylon filament head. This will help to prevent any accidental damage to soft parts of the mouth when brushing the teeth.

• After each use, the brush should be rinsed, dried and stored in a cool place away from the rest of the family’s toothbrushes, preferably in the bedroom (bathrooms are too warm and humid!).

• Patients must change their toothbrush at least every three months, if the bristles have begun to splay (squash out) or following a recent mouth infection.

Toothpaste

• Mild, fluoride toothpaste should be used as this does not make the mouth tingle.

• Patients must keep their toothpaste separate from the rest of the family to prevent cross infection.

• A small size tube of toothpaste can reduce the chances of contamination.

Rinsing

• The mouth must be rinsed thoroughly with ordinary tap water to help get rid of plaque and debris.

Medicines

Mouth ulcers are the most common cause of a sore mouth and are usually treated with a medicine called Difflam. This medicine can be used as a mouthwash or spray. It will relieve pain topically but may cause further stinging in the mouth. It is important that neither food nor very hot or cold drinks are taken immediately after taking Difflam. Before applying any teething gels, please check that they don’t contain aspirin-like drugs as these can affect the way platelet cells work. There are non-aspirin gels available so please ask the pharmacist for advice. Oral pain killers, e.g. Dihydrocodeine or morphine, may also need to be used for pain relief. At times it may be necessary for patients to be admitted to our Unit so that strong pain relief can be given and also to enable eating and drinking.

Assessing the Mouth

Most deterioration of the mouth occurs while patients are at home. Therefore it is important that our patients assess their mouth daily to check that it’s pink, moist, clean and free from infection. The mouth should also be assessed daily using the B.R.U.S.H.I.N.G. technique, which will help to highlight problems of:

Using the B.R.U.S.H.I.N.G. technique daily will alert you to any problems.

Bleeding From gum and teeth margins or infected areas

Redness Around gum and tongue areas

Ulcers Inside the mouth or on the lips (cold sores)

Saliva Too much or too little saliva

Halitosis Tongue and teeth are dirty and furry

Infection White patches on roof of mouth, inner cheek

Non-compliance Unable or refuses to clean teeth

Gingivitis Swollen and shiny gums

If any of the above problems occur, please contact the Oncology Unit or the Shared Care Centre for further advice. It may still be possible for treatment to take place at home.

If you need any further help or advice with any aspect of mouth care please ask a member of our team.

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