WASHINGTON, DC—Through teaching and education, nurses play a critical role in promoting safety for patients with indolent forms of non-Hodgkin lymphoma (NHL) receiving radioimmunotherapy, according to research presented at the Oncology Nursing Society (ONS) 38th Annual Congress.
Radioimmunotherapy selectively targets CD20-positive lymphoma cells with a monoclonal antibody combined with a radioactive agent; in the United States, two agents are approved, 90Y-ibritumomab tiuxetan and 131I-tositumomab. However, the treatment remains “significantly under-utilized” for this patient population, reported Gloria Wood, BSN, RN, of H. Lee Moffitt Cancer Center, Tampa, FL.
To present similarities and differences in the two radioimmunotherapies and discuss the nursing implications for radiation safety, radiation nursing safety procedures were developed that focused on the principles of time, distance, and shielding.
“Decreasing time spent with a patient receiving radioimmunotherapy will decrease radiation exposure,” Wood noted, as will increasing distance. Therefore, it is important to understand the differences between the two agents. For example, tositumomab, with a half-life of 8 days, emits beta and gamma radiation, whereas ibritumomab has a half-life of 64.1 hours and is a beta emitter. “Thus, radiation precautions are even more imperative for tositumomab,” she added.
Safety precautions for the nursing staff center around bodily fluids. This necessitates frequent handwashing, avoiding deep kissing, and using a condom for sexual intercourse during the first week after treatment.
“All staff must wear monitoring badges to monitor radiation exposure as well as lead aprons when coming into contact with tositumomab patients,” Wood noted.
Following treatment with 90Y-ibritumomab tiuxetan, a small amount of radiation treatment may be present in bodily fluids; Nurses instructed these patients to keep the dressing in place for at least 20 minutes, wash hands often, avoid deep kissing, flush the toilet twice, and use a condom during sexual intercourse for at least 1 week following treatment.
Radiation from 131I-tositumomab does penetrate outside the body, putting others at risk for radiation exposure for about 2 weeks following treatment. Nurses instruct these patients to shower daily, wash their hands often, drink plenty of liquids, take thyroid medication, maintain a 6-foot distance from others, use a separate bathroom, sit while urinating, and flush the toilet 3 times with lid down. Dishes and utensils should be washed separately for 1 week after treatment.
For both radiation treatments, blood counts are monitored weekly, and a physician was scheduled to conduct an evaluation 8 weeks after treatment.
To minimize risk of radiation exposure to staff and others, having nurses who are knowledgeable about the background and development of radioimmunotherapy is essential in caring for patients treated with this modality. In particular, decreasing time spent with patients receiving radioimmunotherapy, instructing staff to wear monitoring badges and/or rings to track radiation exposure, wearing lead aprons when coming into contact with patients receiving 131I-tositumomab, and reviewing discharge information with the patient and family members before leaving can all improve the safety of radioimmunotherapy.