Ambulatory Bispecific Therapy

Introduction

You have been given this information sheet because you have been recommended to receive your treatment via the ambulatory pathway via the haematology day unit and virtual ward teams at Cambridge University Hospitals (CUH).

This leaflet has been designed for patients and their family/ carers/ companions to provide an overview of the Ambulatory Delivery Service of Bispecific Therapy. This is available on the haematology day units, as part of adult cancer services at CUH.

Bispecific antibodies are part of a group of treatments called immunotherapies. Immunotherapies are treatments that help the immune system to recognise and kill cancer cells.

What is Ambulatory treatment?

Ambulatory care allows us to offer Bispecific Therapy without you having to stay in hospital as an inpatient in order for us to monitor you for any complications.

Instead of being admitted to a ward to receive your treatment as an inpatient, you will attend the Haematology Day Unit as an outpatient, providing you have a family member or companion/friend that can stay with you at home at all times during the treatment period.

With this treatment there is the possibility that you may suffer from side effects, such as acute inflammatory reactions and/or a rare neurological complication, which means that you will need to be monitored more closely. For this reason, you will be referred to the Virtual Ward Team who will work closely with the Haematology Team. You will receive 24 hour remote hospital monitoring whilst you remain in your own home and additional support will also be given by the Acute Oncology Service (AOS) via the 24 hour emergency triage phone line if you have any concerns.

You will be given the Virtual Ward Information Sheet for a more detailed explanation of how that service will support you.

What advantages does Ambulatory care (AC) offer me?

• You will be able to spend your time away from the hospital either at home or in a comfortable environment, allowing you to rest but with the safety of knowing you are being as closely monitored as you would be as an inpatient.
• Your family member or friend can stay with you at all times. This is not possible if you are an inpatient on the ward.
• You will receive the same treatment and monitoring as on the hospital ward except that we will see you in the haematology day unit at an allotted appointment time, between the hours of 08.00 and 19.00
• You will not be subject to delays in your treatment if inpatient beds are unavailable when you are due your next course of treatment.
• If you are staying at home, we hope that this will add a greater degree of privacy, independence and normality to your treatment experience.

To stay at home you must be able to commit to the following criteria

• Agree to return to the hospital, day or night, if you have any problems, are unwell, or you are contacted by the Acute Oncology Team or Clinical Nurse Specialist Team and you are advised to attend hospital.
• Have a family member or companion/friend staying with you at all times during the treatment period.
• Have a family member or friend available to drive you to the hospital at any time of the day or night. This person must also commit to being available at all times during the treatment period.
• Have a mobile phone so that you are contactable at all times. You must also have access to MS Teams.
• Agree to contact the hospital if you experience any problems or become anxious about any aspect of your treatment.
• Must be signed up to use MyChart.

What happens when I attend the day unit?

• You will be given appointment times to attend for your treatment.
• You will be seen by a nurse, who will take your observations, including temperature, pulse and blood pressure. The nurse will ask if you have experienced any symptoms or side effects of the treatment.
• You will be seen by a doctor if you or the nurse feel that you need to.
• If necessary, bloods or other investigations will be carried out. You may have to wait for the results of these tests.
• You will receive your prescribed treatment. The amount of time you will need to spend in the day unit will vary depending on the treatment you are receiving.
• You will be given a monitor by the Virtual Ward Staff and shown how to use it. You will take the monitor home as this provides continual monitoring of your observations, and these will be linked directly to the Virtual Ward Team. You will then become a patient under the care of the Virtual Ward Team.
• You will receive patient information for the Virtual Ward with their contact details should you have any questions or concerns with the monitoring equipment

You will be reminded of the Acute Oncology Team (AOS) 24-hour numbers to call if you feel unwell at home or develop a temperature of 38 degrees or above.

Staff in clinic and on the day unit will make sure you know how long you should expect each visit to take. Some treatments may take longer than expected, or you may experience delays in your treatment. We will do everything to avoid this but will keep you informed of what is happening if delays do occur.

The day unit team will provide you with any additional medication that you need to take alongside your Bispecific Therapy.

How will this work when I am at home?

The monitor you will be given will send observations of your blood pressure, pulse and temperature to the Virtual Ward Team every four hours and these will be reviewed regularly by the nursing team.

If any concern is raised by the Virtual Ward Nursing Team, they will contact the AOS team directly who will call you to see how you are and talk to you about what happens next.

Due to the possibility of you developing a rare neurological complication you will receive a video call via MS Teams twice a day at around 9am and 3pm. You will be asked a series of questions and will be asked to write a simple sentence. If there are any abnormalities raising concern from this call, you will be asked to attend the Emergency Department straight away. The Emergency Department (A&E) team and the Haematology Doctor will be made aware that you are coming.

If at any point you feel unwell or if your family member/companion/friend is concerned about you, then you MUST call the 24-hour Acute Oncology Service. Do not wait for the Virtual Ward Assessment.

Is there anything I need to do when I am at home?

The aim of ambulatory care is that you continue to lead as normal a life as possible whilst undergoing treatment.

• Plug the monitor in to the mains to recharge whenever possible. It is very important to keep this and your mobile phone fully charged.
• You will need to take your temperature in-between if you feel unwell.
• Depending on your treatment you may need to measure your urine output and keep a record of what you drink. You may need to test your urine each time you go to the toilet. Staff will talk to you about this and provide you with equipment if it is necessary.

How long will I be receiving this Ambulatory Care?

This will be determined by the individual Bispecific therapy you are receiving, and stopping this monitoring will be the decision of your Haematology Clinical Team.

What if I become unwell during my treatment as an ambulatory patient?

It is important that you contact the hospital using the emergency telephone number if you develop any of the following symptoms:

• Temperature of 38oC twice
• Shivers or hot flushes
• Confusion
• Change in your handwriting
• Redness or pain around your hickman line site or PICC

The Acute Oncology Service 24hour emergency number is:

01223 274225 for haematology patients

In an emergency dial 999

Depending on your symptoms, it may be necessary to admit you to hospital. Staff will advise you where to go to be reviewed. If there is availability in the Cancer Assessment Unit (CAU), you will be seen there. Other arrangements will be made if this is not possible.

If you are asked to come to the hospital to be seen it is important that you leave home straight away.

If you are experiencing any infective symptoms such as a runny nose, sneezing, diarrhoea or vomiting please inform us before you attend the hospital as we may need to arrange for you to be seen in a side room.

What happens when my treatment has finished?

Depending on your treatment, you may continue to be seen on the day unit or alternatively an outpatient clinic appointment will be arranged with your clinical team to discuss the next step in your treatment plan.

You should continue to check your temperature as before, and if you develop a fever you may need to be admitted to the inpatient wards for antibiotics. You should ring the 24 hour emergency number if you develop any of the symptoms listed above, regardless of whether it is day or night.