Management of fear of radiation exposure in carers of outpatients treated with iodine-131.

OBJECTIVE: To characterise potential fear of radiation exposure in a normal population of individuals who have volunteered to care for a radioactive family member or friend after outpatient radioimmunotherapy (RIT) treatment for cancer, and obtain their knowing and willing acceptance of the risk. METHODS: Over 750 carers of 300 patients confined to their homes for 1 week following outpatient iodine-131 rituximab RIT of lymphoma were interviewed by a nuclear medicine physicist according to a multi-visit integrated protocol designed to minimise radiation exposure, define risk and gain informed consent. RESULTS: Median radiation exposure of carers was 0.49 mSv (range 0.01-3.7 mSv) which is below the Western Australian regulatory limit of 5 mSv for consenting adult carers of radioactive patients. After signing a declaration of consent, only 2 carers of 750 abrogated their responsibility and none of those who carried out their duties expressed residual concerns at the end of the exit interview with respect to their radiation exposure. CONCLUSION: Fear of radiation exposure in a normal population may be characterised as a normal emotional response. In the special case of carers of radioactive patients, this fear may be successfully managed by rational, authoritative and empathic explanation to define the risk and gain willing acceptance within the context of domiciliary patient care.

Psychological distress of patients undergoing intensified conditioning with radioimmunotherapy prior to allogeneic stem cell transplantation.

This is a pilot study comparing the emotional distress of patients receiving an intensified conditioning regimen (radioimmunotherapy=RIT) with patients receiving conventional conditioning for allogeneic stem cell transplantation. In total, 53 patients (18 received RIT) were given two questionnaires designed to measure emotional distress (HADS, POMS) before starting conditioning (t1) and at discharge (t2). During the in-patient period, patients answered questions daily relating to physical distress, psychological distress, and how they were "coping with the situation". At t2, the transplant team assessed the manner in which the patients were coping. The data displayed no relevant differences with regard to emotional distress between the two groups, both at t1 and t2. For both groups, anxiety and vigor decreased and fatigue increased between t1 and t2. On average, perceived distress was higher for those patients being treated with RIT during the in-patient time, but the differences between both groups were significant only regarding physical distress during the recovery period. No difference was found for the transplant team's assessment. We hypothesize that an intensified conditioning regimen with RIT per se has only a small distressing effect on the patients' psyche during their stay at the hospital. Differences between both groups probably result from independent factors such as, for example, the patients' pre-existing health conditions.

Radioimmunotherapy for non-Hodgkin lymphoma (NHL): nursing and patient perspectives.

This session addressed the major clinical endpoints of radioimmunotherapy trials, dose calculation for single administration of a radioimmunotherapy product, and strategies for the education of patients and caregivers. Attendees learned about the benefits of radioimmunotherapy from the perspective of a survivor of non-Hodgkin lymphoma.

The importance of measuring quality of life in phase I/II trials of cancer therapy--the effects of antibody targeted therapy: Part I.

Phase I/II trials of new cancer therapies are designed to determine safety, efficacy and the optimal regimen for treatment. In order to uphold the principle that 'the interests of the subject must prevail over the interests of science and society' as laid down in the Declaration of Helsinki the effects of these trials on quality of life must be determined. Antibody-targeted therapies are a new form of cancer therapy designed to selectively deliver cytotoxic agents to cancer cells. Twenty-four patients with advanced colorectal cancer were enrolled into trials of three different treatment modalities based on this theme. Quality of life was measured using the Hospital Anxiety and Depression Scale and the Rotterdam Symptom Checklist prior to and 4 weeks after treatment. The Common Toxicity Criteria of the NCI were used to assess treatment related toxicity. There was no significant difference between pre- and post-treatment scores for all three treatment modalities. There was also no significant correlations between toxicity and physical or psychological morbidity. We suggest that the quality of life of patients undergoing phase I/II clinical trials with antibody targeted therapies for metastatic colorectal carcinoma was not adversely affected. We feel that in part this can be attributed to the high level and the intensity of support provided for the patients undergoing these treatments.

The benefits of quality of life measurement in patient care--Part II: A case study.

A case is presented in which quality of life (QOL) assessments were seen to be beneficial. QOL was found to have markedly deteriorated following treatments. As a direct result, appropriate intervention was instigated and QOL improved.