Bacillus Calmette-Guerin (BCG): Information for Patients SAMPLE ONLY. Name: DOB: Your BCG Teaching Session: Date: Time:

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1 Your Health Matters Bacillus Calmette-Guerin (BCG): Information for Patients Name: DOB: Your BCG Teaching Session: Date: Time: What is BCG Therapy? Bacillus Calmette-Guerin (BCG) is a weakened form of tuberculosis bacteria. BCG is an intravesical therapy, which means it is placed directly into the bladder through a catheter or tube. It does not enter your bloodstream. It is a common treatment for bladder cancer that has not invaded the muscle wall of the bladder and it lowers the chance that cancer will return or grow. It works by encouraging the body s immune system to attack cancer cells. Please order from Documents and Media: 415/ BCG schedule: Please see attached sheet for more details BCG induction six treatments, once a week for six weeks BCG maintenance three treatments, once a week for three weeks 1 year program: at 3, 6, 12 months after induction treatment. 3 year program: at 3, 6, 12, 18, 24, 30, and 36 months after induction treatment. Cystoscopy schedule your provider will need to see you in clinic every 3-6 months for surveillance cystoscopies. What can you do before treatment? The morning of your treatment, restrict fluid intake, avoid caffeinated beverages and use of diuretics in the 4 hours prior to the treatment if possible. This will help reduce bladder activity, which may allow for medicine to remain in your bladder longer. SDURO0300 Revised 09/17 There is no need to fast or change your food intake. You can take your regular medications such as blood pressure medication and medications for diabetes management. Find a Doctor: (888) Patient Education Library:

2 What to expect on the day of treatment The bladder instillation procedure is done at the UCSF infusion center or at a local urologist s office by a nurse with special training. Prior to each treatment you will: Have your vital signs taken: If you have any abnormal vital signs, such as elevated temperature, this will be reported to your provider and treatment may be held. Give a urine specimen: It is tested to determine if you are ready for the treatment. If the results show possible infection, your urine will be sent for a culture and treatment will be held. Please report any problems or issues you are having to your nurse such as pain, bleeding or any discomfort. Treatment may be held until symptoms can be alleviated with medications prior to treatment. Instillation: The medication will be instilled into your bladder through the catheter placed by the nurse. You may need to be in the clinic approximately 3 hours to complete the treatment. The Infusion Center has beds available for these procedures so you are more comfortable for the long stay. In some cases, the catheter will be removed from the bladder after the instillation is completed. The medication should be retained in your bladder for up to 2 hours and can be urinated out of the bladder at home. This option is best for patients who live closer to UCSF and do not have a long commute home. After treatment Drink 4-6 cups of fluid. This helps to wash out the remaining BCG from your bladder and reduce irritation. Start doing this after the first time you urinate after instillation. Empty your bladder often. We recommend every 2 hours at the minimum. Instructions to follow each time you urinate within six (6) hours after each treatment: Sit to avoid urine splashing. Do not use public toilets if possible. After each urination, pour two (2) cups of household bleach into the toilet. Close the lid and let the medication and bleach mixture stay in the toilet for minutes before flushing. (If you are unable to complete/perform bleaching, flush the toilet twice with the lid closed) Wipe yourself well with toilet paper and wash your hands thoroughly with soap and water. Wash your genitals with a mild soap or just water to minimize skin irritation. If you experience urinary incontinence (leaking urine unintentionally): Immediately wash clothes in clothes washer. Do not wash with other clothes. If you are wearing an incontinence pad or diaper, pour bleach on the absorptive area, allow soaking in, and then place in plastic bag prior to discarding in the trash. You do not need to do any of these special clean up techniques after the 6 hours post-instillation period. If you are sexually active, use barrier/protection (ie: condoms) with intercourse (including oral intercourse) for one week after treatment, or refrain from intercourse for one week after treatment if barrier/protection cannot be used. 2

3 Until your next instillation The Most Common Side Effects The following side effects are the strongest in the first hours after treatment and should decrease over time. Increased urination or having a very strong feeling to urinate Burning sensation with urination Seeing a small amount of blood in your urine, pink tinged urine is normal in the first 48 hours Low grade fevers ( º F) or muscle/ joint aches Fatigue Sloughing of the bladder lining- this may look like small white/pinkish colored flecks in your urine What you can do to reduce symptoms? Increase hydration after instillation until urine is clear to pale yellow Empty your bladder often, every 2 hours at the minimum Practice double voiding once you have emptied your bladder, wait 1-2 minutes and attempt to empty your bladder again You may use over the counter acetaminophen or ibuprofen (follow dosing instructions on the bottle) for fever and body aches Report ongoing symptoms to your providers so you can discuss different supportive medications When to call your provider If you have fever above 101º F / chills or you are not able to urinate, go to the closest Emergency Department. If you have the following symptoms lasting more than 72 hours after treatment, please call and speak with your UCSF medical team. Urinary frequency, urgency Burning or pain with urination Bright red blood or blood clots in your urine Skin rash If you are concerned about symptoms you are experiencing 3

4 Frequently Asked Questions Can I be on antibiotics while on BCG? Please discuss the specific antibiotics and why you are on them with your medical team. Can I get my flu vaccine or other vaccines while on BCG? Yes, we encourage you to stay up to date on your vaccines while undergoing treatment. Can I have other procedures while on BCG? Yes, there are no restrictions while having BCG. However, you may want to time other procedures before or after you are getting treatment for your comfort. Can I change my BCG schedule for travel? Yes, it is okay to postpone treatment for family events, work trips, and etc. However, we do advise not missing more than one week between treatments, if it can be avoided. We also advise having at least 7 days in-between treatments. I am sick with the flu/have a cold. Can I still have BCG? If you are sick, please stay home and reschedule your next appointment by calling the infusion center at (415) for patients having treatment at UCSF or your treatment facility and notify your medical team. I have read that BCG is more effective if you move side to side and back to front every 15 minutes while the medication is in your bladder to wash all surfaces of the bladder. Should I be doing this while I am waiting in the facility or I go home after the medication is instilled? Historically this has been done, however there is no evidence to support this practice and current guidelines from various physician and nursing organizations do not endorse this practice. 4

5 Tracking Your BCG Therapy Name: DOB: MRN: Year Months Cystoscopy BCG Notes month break 6 3 month break #1 Usually starts 2-6 weeks after surgery #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16 #17 #18 #19 #20 #21 #22 #23 #24 #25 #26 #27 42 Cystoscopy every 6 months x 2 years * may be adjusted based by your physician

6 Notes: 6

7 Notes: 7

8 Notes: 8