Congress Abstracts 2003

54

ARSENIC TRIOXIDE: NURSING CONSIDERATIONS FOR SAFE ADMINISTRATION. Bonny Mombrea, RN, BS, OCN^®, and Kelly Stawicki, RN, Roswell Park Cancer Institute, Buffalo, NY.

Arsenic trioxide (ATO) has been used medicinally in ancient Greece and Rome for over twenty four thousand years. More recently, interest in arsenic-based therapy was revived by reports of the anti-leukemic activity in some traditional Chinese preparations. Roswell Park, our comprehensive cancer center, is currently using ATO along with the other centers in a Phase II study for myelodysplastic syndromes (MDS). It has been FDA approved for the treatment of promyelocytic leukemia (APL). ATO has also been used in combination with other chemotherapies for the treatment of other hematological malignancies and solid tumors. ATO may lead to partial or complete remission of disease and can be given in a clinic setting.

Arsenic trioxide can have severe adverse effects. It causes morphological changes and DNA fragmentation. ATO converts immature cancerous white blood cells into normal white blood cells, resulting in an elevated white blood cell count. “APL Differentiation Syndrome,” inflammation and fluid accumulation, particularly in the lining of the heart and lungs, can also accompany ATO use and can be fatal. ATO can increase the Q-T interval and, in some cases, lead to fatal irregular heart rhythms. Careful nurse monitoring for the subtle signs and symptoms is crucial.

Psychosocial support and patient education are essential in ATO treatment. Most of the general public associate arsenic with poison. For example, in the play Arsenic and Old Lace, arsenic is used as a murder weapon. Arsenic has also been used to exterminate insects and rodents. A common reaction by patients: “You want to put poison in my body?!” The nurse has an important role in educating the patient about non-toxic doses of ATO, effects, potential reactions to ATO, and reassuring the patient that they will be thoroughly monitored.

This poster presentation will highlight nursing considerations regarding the following: Pre-treatment assessment, testing, dosage, administration of ATO, infusion considerations, monitoring for “APL Differentiation Syndrome,” electrolytes, blood chemistries, hematology, and cardiac status. In addition, it will summarize recommended tests during treatment with rationale, give common drug-related toxicities including the follow-up treatments, and identify benefits of treatment with ATO.