I've just been told I have blood cancer

If you’re having active treatment, you’ll have a hospital medical team to look after you, whether you stay in hospital or just visit for appointments.

The key people in your medical team are your clinical nurse specialist (CNS), who’s your main point of contact day to day, and your consultant, a specialist doctor. Your consultant is usually a haematologist (an expert in blood diseases), although you could be seen by an oncologist (someone who treats cancer in general).

Your CNS and consultant are part of a larger multidisciplinary team (MDT), who should get together to discuss your care at important points, such as when you need to start treatment.

Your medical team at the hospital will keep your GP informed about your diagnosis and any treatment you’re having. Your GP will still be involved in caring for your general physical and mental health.

If you’re on active monitoring (watch and wait), your GP may be in charge of monitoring your condition.

If you're unsure about anything but don't feel comfortable talking to your medical team, get in touch with our Support Service – we'll be happy to talk things through. Contact us on 0808 2080 888 or [email protected]. Our opening hours are as follows:

• Monday: 10am – 4pm
• Tuesday: 10am – 7pm
• Wednesday to Friday: 10am – 4pm
• Saturdays: Closed
• Sundays: Closed
• Bank holidays: 10am – 1pm

Or you can leave a message and we'll get back to you.

You’ll have tests to find out about the type of blood cancer you have and check on your condition. You'll also have tests to check how well any treatment is working and to plan the next steps.

Doctors may run these tests on a sample of your blood, or a small piece of tissue, usually from a gland or your bone marrow. You may also have scans.

Your healthcare team will be on hand to explain what each test involves, why you need it, and what the results mean.

If you're diagnosed with a very acute (fast-growing) blood cancer, you will usually start treatment within a few days. Other types of blood cancer develop more slowly, so it may be a few weeks before you start treatment.

Starting treatment very quickly or having to wait a while for treatment are both difficult situations to deal with. Our Support Service is here to listen and help you process what’s happening.

Some people with a slow-growing (chronic) blood cancer may not need treatment for months or even years. They’ll be put on active monitoring (watch and wait), which means having regular tests and check-ups but no treatment. This is often recommended if your symptoms are manageable, and the side effects of treatment could make you feel worse. Being on watch and wait doesn’t affect the outcome of any treatment you have in the future, and it’s better for your general health if you only have treatment when you need it.

It can be frightening and confusing to be told you don't need treatment. Speak to your medical team or GP, or contact us if you have any questions.

You can also join our online community forum to connect with other people on watch and wait.

You'll probably have lots of questions about tests, treatment and your future. Sometimes these don’t come to mind until after an appointment, so it might help to think about them beforehand and write them down.

Your medical team are there to answer all your questions about treatment, side effects, how you’re feeling emotionally as well.

To help you start the conversation, we have some suggestions for questions you might want to ask:

Most people with a diagnosis of blood cancer will be under the care of the haematology department at their hospital. Haematology means the study of the blood. Sometimes people with blood cancer will be treated in the oncology (general cancer) department.

Since the coronavirus pandemic started, there have been changes to the way medical teams are seeing patients and giving treatment. This is to keep you safe.

At an already difficult time, any uncertainty about how or where you'll be treated can be hard to deal with. Don't be afraid to ask your medical team any questions which come to mind – you should have contact details for your clinical nurse specialist (CNS) or another key worker. Ask for contact details if you haven't been given any.

If you're not confident about talking to your team just yet, our Support Service can give you tips on how to get the information you need. If you'd like a family member or friend to talk to us, that's fine too.

If at any time you’re struggling to get in touch with your team, follow these steps:

• Call the haematology department (you'll find the number on the hospital website) and ask for your nurse or doctor to call you back.
• Try sending an email so your request to speak to someone is in writing.
• Contact your local patient advice service for support – these organisations aren’t just for complaints, but to help with any concerns you have about your care. In England, contact the Patient Advice and Liaison Service, in Scotland the Patient Advice and Support Service (PASS), and in Wales your local Community Health Council (CHC). In Northern Ireland, ask your hospital how you can raise a concern.
• Contact us for support on freephone 0808 2080 888 or [email protected]

One change that’s happened since the coronavirus pandemic started is that you’re more likely to have virtual appointments with your medical team.

In the past, it was more normal to have face-to-face appointments. At diagnosis, you’d usually be seen by your consultant (specialist doctor) and a clinical nurse specialist (often your key contact at the hospital). Together, they’d answer your questions and explain anything you didn’t understand.

Since covid, it’s become more common to get your diagnosis and have follow-up discussions by phone or video call. This is mainly to protect you from the risk of infection by cutting down on your visits to hospital.

Some people find it very difficult to have these conversations over the phone. Others see advantages such as not having to travel, and having relatives who don’t live nearby involved in the call.

Everyone is different and virtual appointments certainly don’t suit everyone. If you’d prefer to see your doctor or nurse face to face, ask for that – it may be possible. You can also ask about your hospital’s plans to offer face-to-face appointments in the future.

Read our blog for tips on how to make the most of virtual appointments.

There are different types of hospital appointment you may need to attend, depending on your diagnosis and the reason for the appointment.

• Outpatient appointment: You may be seen as an outpatient, meaning you don't need to stay in overnight. This might be for tests or check-ups.
• Day unit appointment: You might visit the day unit one or more times a week to have treatment, going home in between appointments.
• Inpatient stay: Your treatment might mean you have to stay in hospital overnight or for a number of days. Your healthcare team should discuss this with you and let you know which ward you’ll be staying on.

You can ask your consultant or key worker (usually your clinical nurse specialist) what you need to bring to your appointments. Some people find it useful to bring a small overnight bag and toiletries even if they're not expecting to stay in hospital. This is just in case they’re unexpectedly asked to stay overnight, for example because of an infection or a high temperature.

It's also a good idea to have something to do while you're waiting or having treatment, particularly if you're on your own. People often take a book or a magazine, play games or videos on their phone, or bring an activity they can easily carry around such as knitting.

Many people find it helpful to take someone with them to appointments. There’s a lot of information to take in, so if you have a family member, friend or neighbour who's willing to go with you and take notes it can be a great support. If your appointment is a virtual one, ask if someone can be invited to the conference call to do the same thing.

You may be asked to go to face-to-face appointments on your own. This is one of the ways hospitals are trying to protect you during the pandemic, but many people are finding this really tough.

We will do our best to help. Our Support Service can talk through any worries you have before and after your appointments and help you find ways to feel more in control. Call us free on 0808 2080 888 or email [email protected]

Travelling to hospital may be expensive, especially if you need to go regularly for treatment or check-ups. You may be able to get help with travel costs and some hospitals may offer their own transport in certain circumstances. Ask your clinical nurse specialist (CNS) or contact our Support Service for help.

If you have a diagnosis of blood cancer but don't need treatment, just monitoring, read our information on watch and wait.

If you have a diagnosis of blood cancer and need to start treatment, you and your medical team will consider the options, based on:

• the type of cancer you have
• your general health and the results of any tests you’ve had
• what treatments are available and how well they work
• any risks or side effects
• whether there are any relevant clinical trials available.

You’ll also discuss:

• the benefits and risks of the treatment
• the aims of the treatment and the possible outcomes
• your thoughts, feelings and wishes.

These are the main types of treatment that are used for blood cancer:

• Chemotherapy (chemo) uses drugs which kill cancer cells or stop them growing. Usually, chemo involves a combination of two or more different drugs. Sometimes, this combination includes drugs called steroids, which help treat the cancer or its symptoms.
• Targeted therapy involves drugs which work by targeting the genetic changes that cancer cells have, which normal cells don’t have. They can find and kill cancer cells, or block the chemical signals which tell cancer cells to keep multiplying.
• Immunotherapy uses your body’s own immune system to find and kill cancer cells. CAR-T therapy is a type of immunotherapy.
• Radiotherapy is treatment with radiation, which can be used to target blood cancer cells that cluster in a particular part of the body, forming a lump. You might also have radiotherapy before a stem cell transplant.
• Stem cell transplant is a treatment that uses high doses of chemotherapy, and sometimes radiotherapy, to wipe out all the blood cancer cells in your body, before giving you new healthy stem cells. The new stem cells can be your own or come from a donor, and are given to you through a drip. They will grow into new healthy blood cells in your body.
• CAR-T therapy involves taking white blood cells called T cells out of your body, genetically modifying them in a lab to make them more effective at killing cancer cells, and then putting them back into your bloodstream. CAR-T therapy is available for some people with certain types of blood cancer whose previous treatments haven’t worked.

You may have other treatments to help manage the symptoms of blood cancer or the side effects of treatment. These include anti-sickness drugs, painkillers and blood transfusions. You may also have injections of medicines called growth factors to boost your blood cell count.

The side effects of blood cancer treatment depend on the type of treatment you have, and on your own health and circumstances. So two people who have the same treatment can have different side effects.

Your medical team will tell you about possible side effects and how to manage them. Make sure you let your team know as soon as you notice any changes in your body or how you feel. There are often things that can be done to help, and spotting side effects early can make treating or managing them easier.

Some blood cancer treatments can affect your fertility, but there may be ways to increase your chances of having a child when you’re ready. These can include freezing eggs or sperm.

If you know you want to have children, or think you may want to in the future, talk to your medical team as soon as you can, ideally before you start treatment.

If you’re unsure about the care you’re receiving, speak to your healthcare team in the first instance. They may be able to answer your questions and reassure you.

If you’re still unsure about your diagnosis or your treatment plan, you can ask for a second opinion from another doctor. It's not an automatic right, but your GP or your specialist doctor (your consultant) will usually be happy to refer you.

If you aren’t happy with the care you’ve received, there are services that provide support and information for people who have concerns about their healthcare. In England this is the Patient Advice and Liaison Service (PALS), in Scotland it’s the Patient Advice and Support Service (PASS), and in Wales it’s the Community Health Councils (CHCs). Ask about these services at your hospital. In Northern Ireland, ask your hospital how you can raise a concern or complaint.