Intrathecal chemotherapy

Intrathecal chemotherapy Chemotherapy A guide for patients and carers

Contents What is intrathecal chemotherapy?... 1 Why do I need intrathecal chemotherapy?... 1 What will happen before the procedure?... 1 How is intrathecal chemotherapy given?... 2 How many treatments will I need?... 3 Are there any side effects or risks?... 4 Contact telephone helpline... 4 Additional information... 5

1 What is intrathecal chemotherapy? Intrathecal chemotherapy is the injection of chemotherapy into the fluid which surrounds the brain and spinal cord to protect and cushion it. This fluid is called cerebrospinal fluid (CSF). Why do I need intrathecal chemotherapy? With some types of cancer, cancer cells can pass into the CSF. Chemotherapy given by mouth or intravenous injection cannot cross over into CSF. The best way to treat cancer in the CSF or prevent cancer from spreading to the CSF is to give chemotherapy directly into the fluid. What will happen before the procedure? The cancer doctor and nurse will give you verbal and written information about the drugs and the procedure and will gain your written consent for this procedure. As this is a special procedure, it will take place on Delamere Day Case Unit in an allocated room where staff who have had specialist training will carry out the procedure. The cancer doctor and the nurse will check the chemotherapy drug for the following Correct drug Correct dose Correct patient Correct route of administration

2 We will encourage you or, if you wish, a friend or relative to be involved in the checking procedure. When all checks are complete the doctor will administer the drug into your CSF. How is intrathecal chemotherapy given? There are two possible ways to give intrathecal chemotherapy via lumbar puncture or via Ommaya reservoir. Your cancer doctor will advise which method is best in your case. 1. Intrathecal chemotherapy via lumbar puncture Giving treatment by lumbar puncture will take about 15 to 30 minutes and it is important that you stay still. However, let the cancer doctor or nurse know if you are uncomfortable or are in pain. We will help you into one of the following positions for the procedure: Lying on your side with your knees drawn up to your tummy. OR Sitting with your back towards the doctor, your arms folded and supported over a pillow or the back of a chair, with your head resting on your arms. The procedure in either position continues as follows: The doctor will clean the skin on your lower back with antiseptic cleansing agents, then give you a local anaesthetic.

3 When the local anaesthetic has numbed the area, the doctor will insert a needle into your spinal fluid. The doctor will remove a small amount of CSF and then slowly inject the chemotherapy drug. The needle will then be removed and a small dressing used to cover the injection site this can be removed after 24 hours. You will need to rest after treatment and lie flat on your back for 1-2 hours to reduce the risk of headache. 2. Intrathecal chemotherapy via Ommaya reservoir Some patients may attend The Walton Centre NHS Foundation Trust to have an Ommaya reservoir port implanted under the skin on the scalp. This is done as a surgical procedure. Once the skin is healed we are able to inject chemotherapy to the CSF via the Ommaya reservoir without having to undergo a lumbar puncture each time. In addition, injecting chemotherapy via an Ommaya reservoir does not require a local anaesthetic. How many treatments will I need? Usually intrathecal chemotherapy treatments are given once or twice per week to begin with for several weeks. After that your doctor will advise you how often you need to attend for further treatments.

4 Are there any side effects or risks? The most common side effect is a headache within the first 24 hours. If you develop a headache it may help to lie flat, take some painkillers (e.g. paracetamol) and drink plenty of fluids. If the headache does not settle or you start to feel sick, you should contact us on the telephone helpline for advice. If you have treatment via a lumbar puncture, you may also have back pain where the needle was inserted and/or shooting pains in your legs but these should settle in 48 hours. Following intrathecal chemotherapy if you have persistent headache or pain in the back or legs that has not settled in 24 hours please contact us on the telephone helpline. Clatterbridge Cancer Centre Hotline 0800 169 5555 If you are unwell during or up to 8 weeks following your cancer treatment please call the Clatterbridge Cancer Centre Hotline. Your call will be answered by a dedicated nurse advisor. This line is available 24 hours a day, 7 days a week.

5 Please call the hotline if you have any queries, but it is particularly important if you are experiencing any of the following: Suddenly feel unwell A temperature greater than 37.5 C Any unexplained bruising or bleeding Diarrhoea for more than 24 hours Unrelieved shortness of breath Mouth ulcers that stop you eating or drinking Additional information Macmillan fact sheet: Lumbar puncture and intrathecal chemotherapy can be found at www.macmillan.org.uk. The Clatterbridge Cancer Centre NHS Foundation Trust Patient Information Leaflet Eating well & coping with side effects. Macmillan booklets about coping and living with cancer and treatment side effects are available free of charge. These can be ordered by telephoning 0808 808 0000 or by visiting a Macmillan Information Centre (sited in the main entrances of Clatterbridge Cancer Centre - Wirral and Clatterbridge Cancer Centre - Aintree).

How we produce our information All of our leaflets are produced by staff at The Clatterbridge Cancer Centre and this information is not sponsored or influenced in any way. Every effort is made to ensure that the information included in this leaflet is accurate and complete and we hope that it will add to any professional advice you have had. All our leaflets are evidence based where appropriate and they are regularly reviewed and updated. If you are concerned about your health in any way, you should consult your healthcare team. We rely on a number of sources to gather evidence for our information. All of our information is in line with accepted national or international guidelines where possible. Where no guidelines exist, we rely on other reliable sources such as systematic reviews, published clinical trials data or a consensus review of experts. We also use medical textbooks, journals and government publications. References for this leaflet can be obtained by telephoning 0151 556 5570. If you need this leaflet in large print, Braille, audio or different language, please call 0151 556 5570. If you have a comment, concern, compliment or complaint, please call 0151 556 5203. The Clatterbridge Cancer Centre NHS Foundation Trust Clatterbridge Road, Bebington, Wirral, CH63 4JY. Tel: 0151 556 5000 Web: www.clatterbridgecc.nhs.uk Issue date: 01/02/17 Issue no: 4.0 Reference: LCHAINTR Review date: 01/02/20