Evolution and management of BCG

At EAUN18 I attended the Thematic Session 10 on bladder cancer with the theme “Evolution and Management of BCG,” an area which I focus on as a urology clinical nurse with a sub-specialty in non-muscle invasive bladder cancer.

I found the session very useful in understanding the history, in detail, of Bacillus Calmette–Guérin (BCG), a drug which many nursing professionals do not fully understand, particularly the mechanisms of how it works. It was valuable to hear the insights of experts which gave me a better understanding of BCG as a complex drug.

With the worldwide shortage it was valuable to recognise how other disciplines try to plan and work around this, enabling me to inform my centre of how other healthcare professionals manage these shortages, reducing the negative impact on patients’ treatment schedules. As I was also unaware of the process involved in developing each batch, and the length of time this takes, it was beneficial to understand how these shortages can occur, with little warning, such as during incidents of ‘a bad’ batch. The management of side effects and a patientcentred approach were also very informative issues.

In my centre we take a very patient-centred approach and it was reassuring to see that we are providing this treatment at the same level as other centres. I will, however, use the new information I
have learned and with renewed confidence continue to manage the side effects as effectively as possible, thereby ensuring patients are able to continue their treatment.

I also asked questions regarding a practice that we have done historically, which is to take UE, FBC and LFT bloods following each cycle of BCG. We planned to review this as we felt it was not relevant unless the patient have had significant side effects from their treatment. The opinions of the experts were helpful which enabled me to provide some feedback to my colleagues at our centre. This resulted in this practice been withdrawn and the decision of taking blood post-treatment is now left to the clinical decisionmaking of the nurse specialist providing the individual patient care.

Overall, my knowledge of BCG has greatly improved and I feel more confident in discussing the drug with patients and colleagues. In my view, the more knowledge we have regarding these drugs, the better then we can provide the right care and treatment to our patients. In my experience, when we can confidently respond to their questions, they develop more trust and can feel more relax during their treatment.

Laura Noble, Uro-Oncology Clinical Nurse Specialist, Freeman Hospital, Dept. of Urology, Newcastle upon Tyne (UK),