Current Radionuclide Treatments and Indications

Grubbs reviewed key nursing considerations for each radionuclide currently approved for treatment of cancer.

Radium 223 is an injection for castration-resistant prostate cancer that has spread to bone. It mimics calcium and forms complexes with bone minerals in those metastases, and the radiation effect as it decays and causes an antitumor effect, she explained. Nurses should monitor blood cell counts throughout treatment and watch for nausea, diarrhea, vomiting, and swelling in the legs and feet. Caution patients with partners of reproductive potential to use effective birth control during treatment.

Yttrium Y-90 is given as an outpatient procedure by injecting microspheres via an arterial catheter that emit pure beta radiation into liver tissues to treat unresectable hepatocellular carcinoma, metastatic liver cancer, and cholangiocarcinoma. Side effects are dose-dependent, Grubbs said, and may include abdominal pain, nausea, and vomiting. Monitor liver function tests after injection.

Yttrium-90 ibritumomab tiuxetan is an IV infusion used in combination with rituximab to treat low-grade or follicular B-cell non-Hodgkin lymphoma (NHL) that is CD20-positive and has relapsed during or after treatment with other anticancer drugs. It’s an antibody treatment that binds to CD20-positive malignant B cells. It also is indicated in newly diagnosed follicular NHL following a response to initial anticancer therapy. Patient education involves discussion of the infusion schedule, the importance of monitoring platelet counts, and the need to be careful with patient waste (for example, sitting to void, wiping up any spills), but patients do not need to stay distanced from others. Nurses should be aware of the possibility of extravasation, Grubbs said.

Radioiodine l-131 is the gold-standard treatment for thyroid cancer. It can be delivered via an oral solution or pill, usually in the inpatient setting, dependent on dose. Safety considerations include:

• Stay six feet away from the patient for the first 24 hours, then three feet away for the next five days.
• Excretions are radioactive and should be handled with care.
• Patients should bring minimal personal items to treatment, dispose any items used for eating, and not use the shower.
• Use banners to close off the room until cleared by radiation safety.
• Radiation measurements should be taken until they reach a safe level, at which point the patient can be discharged with instructions.

Lutetium lu 177 dotatate is an IV infusion for refractory neuroendocrine tumors that targets somatostatin receptors on cancer cells. Patients are premedicated with antiemetics and amino acids, and female patients must have a negative pregnancy test. Safety precautions are similar to radioiodine l-131.

Nurses’ Role in Implementing Radiopharmaceutical Programs

Sharing her own experience in developing a radiopharmaceutical program, Grubbs suggested that nurse leaders:

• Create calendars to organize medical oncology, nuclear medicine, radiation safety, nursing, and outpatient chemotherapy.
• Ask radiation safety specialists to collaborate on creating a photo album and resource documents to illustrate safe administration, to be available in each treatment area.
• Educate staff, particularly nurses of childbearing age, about occupational safety.
• Establish radiation champions to answer questions and get staff buy-in.
• Create multiple layers of patient education before, during, and after therapy, such as websites, booklets, and other handouts.

“Communication and knowledge-sharing are essential. We had talks and meetings for a year prior to implementation,” Grubbs said. “Take an interprofessional approach. Make diagrams of the patient journey to include everyone who will touch the patient. Involve everyone in all aspects of planning, and make patient education available at every step.”