Page 41 Complete Your CE Test Online - Click Here lexidronam (Quadramet®), strontium-89 chloride (Metastron®), and radium 223 (Xofigo®) are used for this [189]. Patients who have radioactive liquids injected are typically instructed to follow special precautions for a few days. Restrictions are partly based on whether there are young children in the home, since they tend to require closer proximity and more contact than older children, and because younger people are more affected by radiation than older ones. This needs to be communicated to the patient, who should be sent home with full written instructions. Typical radiation exposure risks for the family of patients going home after 131-Iodine for thyroid cancer or radionuclides for bone metastases are minimal. The total radiation dose to others, even with close prolonged contact, is expected to be low enough that it should not cause harm to other adults. Also, radioactivity drops off quickly. For an extra margin of safety, patients are often given instructions to [97,269]: ● ● Sleep in a separate room and use a different bathroom from other family members for two days after treatment. Some practices encourage double flushing after toilet use, with good hand washing after. ● ● Avoid public transportation for the first day after treatment. ● ● Avoid public places for the first two days after treatment (e.g. restaurants, theaters, shops, etc.). ● ● Any pregnant women or children under two years should stay at a different residence for three days after treatment. ● ● Maintain a distance of about three feet or more from other people for up to three days after treatment. ● ● Clean up any spills of urine, blood or other body secretions carefully. Wash any contaminated linens carefully. Body fluids such as saliva, urine, and sweat can contain small amounts of radioactive material. ● ● For those who are sexually active and able to conceive a child, it is recommended to use birth control for at least 30 days after radiopharmaceutical dosing to reduce the risk of fetal effects. Brachytherapy Brachytherapy can take the form of seeds, pellets, ribbons, wires, or capsules that are injected into or near the tumor. Some are left in and others are removed [189]: ● ● Permanent brachytherapy devices give off a low total radiation dose to the immediate area, and are left in place while the radioactivity decays quickly over a few weeks. Generally, this is done on an outpatient basis, with few or no precautions for close family members. ● ● Low-dose rate implants are only left in for a day or so, up to a week, before being removed. ● ● High-dose rate implants stay in for a few minutes at a time and are taken out, although an applicator or catheter is usually left in place until the course of radiation is completed. Staff and family will need to limit the time they spend with the patient while the high-dose and low-dose devices are in place. Chemotherapy and drug treatments for cancer Chemotherapy is what most people think of when they think of cancer treatment, even though drug options have greatly expanded for many types of cancer. Chemotherapy (or chemo) is used to treat many types of cancer but it is usually not the only modality used for cancer treatment. Most often, chemotherapy is given in concert with other cancer treatments. The types of treatment depend on the type of cancer, if the cancer has spread and where, and if there are co-morbidities that call for modification of treatment. Before the patient starts chemotherapy, it is advisable to review previous teaching points, such as treatment plan, the purpose of the chemotherapy, and adjunct treatments. For those who are receiving at least part of their chemo as outpatients, appointments for lab testing and follow-up should be emphasized. Be sure to include family caregivers and other family members who may be called on for help when the patient is incapacitated in some way. Make sure they know when to call, and ways to get help during nights, weekends, and holidays. If the patient is a smoker and has not quit, this is again a good time to discuss possible supports for quitting such as nicotine replacement therapy or other pharmaceuticals. One study showed that patients who were receiving chemotherapy for leukemia who continued to smoke were more likely to have serious pulmonary infections than those who quit [194]. Purpose and goals of chemotherapy Chemotherapy works by stopping or slowing the growth of cancer cells, and is used in the following ways. It is important for the patient to know what their therapy is intended to do [152]: ● ● Treat cancer with curative intent: Chemotherapy can be used with the intent to cure, although the patient must obviously know that there is no guarantee that a cure will result. ● ● Reduce the risk of recurrence: This type of treatment is used to decrease the chance the cancer will come back by eradicating micrometastases and other cancer cells that could resume growing. ● ● Stop or slow cancer growth: Maintenance or chronic treatment in patients with cancer that is too widespread or refractory for the possibility of cure. ● ● Palliative care: Can be used for the purpose of minimizing symptoms and reducing discomfort by shrinking tumors that are causing pain and other problems. How chemo is used with other treatments When used with other treatment modalities, chemotherapy can [152]: ● ● Shrink a tumor before surgery or radiation therapy (neoadjuvant chemotherapy). ● ● Destroy cancer cells that may remain after surgery or radiation therapy (adjuvant chemotherapy). ● ● Boost effects of other treatments. ● ● Kill cancer cells that have returned or metastasized. Chemo routes Chemotherapy drugs may be given one or more of the following routes: ● ● Oral. ● ● Intravenous (IV). ● ● IM or SC injection. ● ● Intrathecal. ● ● Intraperitoneal (IP). ● ● Intra-arterial (IA). ● ● Topical (which the patient usually self-applies at home). Vascular access Despite the availability of other routes for many cancer treatment drugs, reliable venous access is essential for many types of cancer treatment. IV devices designed for short-term medical situations can quickly become impossible to maintain in the face of repeated cycles of chemotherapy. Veins become damaged from frequent entry and cannulation for medications (including irritants and vesicants), fluids, transfusions, and blood draws. It becomes a painful and sometimes futile exercise to try and replace short peripheral IV devices. Over time, the number of failed attempts to start IVs or draw blood for labs rises; and the risk of infiltration and phlebitis also increases as fewer and smaller “good” veins can be found. All of this poses risk to the patient and necessitates a long-term IV access plan, preferably before peripheral access becomes difficult. Long-term IV chemotherapy is most often given through a wide assortment of devices such as central lines, tunneled catheters, and implanted ports or reservoirs. Some of the specialized vascular access devices have two or three lumens, which can be used to give solutions that cannot be mixed. A port is a small, round disc with a penetrable top membrane connected to a catheter in a large vein, most often in