Introduction
The Non-surgical Oncology Sub-groups (NOG) of the Tumour Site Specific Groups (TSSG) are responsible for the maintenance of the Oncological Treatment Guidelines and Kent & Medway Systemic Anti-Cancer Therapy (SACT) protocols. Reference should be made to the ‘organisational structure and governance processes for chemotherapy protocols'.
Governance
Before KMCC SACT Protocols are used within each acute Trust, they should be ratified for use through the Local Chemotherapy Group. Changes and additions to the KMCC SACT protocols should be formally requested at a NOG meeting or sent in writing to the Chair of the NOG for discussion and ratification.
Responsibilities
The NOGs are responsible for the accuracy of the information contained within the agreed protocols.
The KMCC Network Pharmacist is responsible for ensuring the Network SACT protocols are reviewed and updated at least every 2 years. Oncology and haematology pharmacists working within KMCC have a responsibility to contribute to this workplan.
The technical maintenance of the Aria E-prescribing system is the responsibility of MTW.
When a protocol is withdrawn, an amendment made or a new protocol created, The Network Chemotherapy Group together with the relevant NOG(s) will be notified via e-mail at the point the protocol is available for use.
The Chemotherapy Heads of Service and Oncology Lead Pharmacists are all represented on the Network Chemotherapy Group and are responsible for disseminating this information within their own organisations.
Prescribing of unfunded medicines
The Non-surgical Oncology Sub-groups (NOGs or HOG) in consultation with the Network Chemotherapy Group within the Kent and Medway Cancer Collaborative agree chemotherapy treatment algorithms to be used within their specialty. These are described within the Oncological Treatment Guidelines. A KMCC SACT protocol will only be created for regimens described within the NOG approved oncological treatment guidelines. Some of these protocols may be unfunded where they are not subject to a positive NICE technology appraisal or funded by the Cancer Drugs Fund. Reference should be made to the SACT funding spreadsheet available in Knowledge Tree. The process to request funding for an unfunded medicine is set out in the KMCC Policy for the Management of Algorithm Deviations and the use of unfunded medicines which form part of treatment algorithms as defined in the Oncological Treatment Guidelines.
Clinical Trials
Patients may also be considered for enrolment in a clinical trial and where this is the case, the clinical trial protocol should be followed.
G-CSF
G-CSF may only be used as an adjunct to chemotherapy in accordance with the Kent and Medway Cancer Collaborative Policy on the use of G-CSF.
Cisplatin Hydration
Where Cisplatin is given, the KMCC Cisplatin Hydration schedule should be followed.
Dose Adjustment
Consideration should be given to adjusting the dose of chemotherapy in patients who are obese. Advice may be sought from the Oncology or Haematology Pharmacist.
Patients with renal or hepatic impairment may require reductions in the dose of chemotherapy. The level of dose reduction will vary depending on many factors including patient performance status, organ function, disease involvement and therapeutic intent. Advice may be sought from the Oncology Pharmacist or the Medicines Information Department. The NLCN dosage adjustments for cytotoxics in renal and hepatic impairment guidelines may be used as a source of information.
Miscellaneous
Please be aware that some drugs, such as anthracyclines and bleomycin can cause severe toxicities if the maximum cumulative dose is exceeded. Please seek advice from your local Oncology/Haematology Pharmacist.
Consideration should be given to reducing or omitting the dose of Dexamethasone when given as an anti-emetic to patients with diabetes, or patients on regular steroids for any other indication. Alternative anti-emetics should be considered.