General guidance on malignant disease

Prescribing Notes:

An ever-increasing number of cytotoxic drugs and biological therapies - now referred to as Systemic Anti-Cancer Therapy (SACT) - are used in the management of malignant disease. The recommended doses and schedules vary according to the tumour type and regimen and are beyond the scope of this document.

SACT should always be prescribed under the supervision of a cancer specialist. Specialists prescribing SACT should refer to Edinburgh Cancer Centre (ECC) clinical management guidelines and treatment protocols, which contain details of treatment regimens, side effects, dose adjustments, and supportive care. With the exception of hormonal treatments, when oral SACT is used for the treatment of cancer, the whole course is most commonly dispensed by the hospital pharmacy. The prescription should not be repeated except on the explicit instruction of a specialist under an agreed shared care arrangement.

Cytotoxic chemotherapy is known to be potentially carcinogenic, mutagenic and is hazardous as defined by the COSHH regulations (2002). There is evidence to indicate that health care professionals involved in the preparation and administration of chemotherapy drugs can, if not using adequate safe handling measures, absorb potentially harmful quantities of these compounds. Under COSHH regulations 2002 and CEL 30 (2012) all staff working with chemotherapy agents must be made and kept aware of risks and the circumstances under which they may be exposed to a carcinogen and all necessary measures should be adopted to protect staff from occupational exposure.

See links to information and formulary recommendations for conditions and side-effects associated with malignancy. Recommendations for the treatment and prevention of venous thromboembolism are available in the Cardiovascular chapter of the formulary. Also refer to Edinburgh Cancer Centre antithrombotic guidelines for more information.

Guidance for the safe use of systemic anti-cancer therapy SACT can be accessed on the local NHS board intranet pages. In NHS Lothian refer to The Oncology Online Quality System (OOQS) - Guidelines for the Safe Use of SACT. This page also includes master prescription charts and associated materials.