Congress Abstracts 2004

71

THE NURSING ROLE IN THE SUCCESSFUL IMPLEMENTATION OF A CLINICAL TREATMENT TEAM FOR RADIOIMMUNOTHERAPY WITH ZEVALIN (90Y IBRITUMOMAB TIUXETAN. Christine Pellegrini, RN, MSN, Shashi Khandekar, CNMT, Meredeth Shelley, RN, and Barbara Tripp, RN, MSN, AOCN^®, Cleveland Clinic Foundation, Cleveland, OH.

Zevalin was the first radioimmunotherapy (RIT) agent approved by the FDA. RIT is an emerging therapeutic option for certain patients with non-Hodgkin lymphoma. From our experience at the Cleveland Clinic, we offer guidelines for oncology nurses in establishing and implementing a multidisciplinary treatment team for Zevalin RIT involving healthcare professionals in oncology, radiation oncology, nuclear medicine, radiation safety, scheduling, and finance.

The oncology nurse must educate patients, families, and caregivers; monitor and manage side effects; follow up after treatment; and manage logistics and supportive care.

The Zevalin regimen is administered as an outpatient procedure over 7–9 days. On day 1, the patient is given an infusion of rituzimab (administered by the oncology nurse), followed within four hours by a slow intravenous injection of 111In Zevalin over 10 minutes (administered in nuclear medicine). Whole-body gamma scans are performed to confirm the expected biodistribution of the antibody at 2–24 hours and at 48–72 hours after the 111In Zevalin injection. The radiation oncologist or nuclear medicine physician reviews the scans with the patient and their family and answers their questions. If the biodistribution is as expected, on day 7, 8, or 9, the patient returns to the radiation oncology or nuclear medicine department and is given an injection of 90Y Zevalin. The 90Y Zevalin is preceded within four hours by an infusion of rituximab, administered by the oncology nurse. At the Cleveland Clinic, 90Y Zevalin is administered by the radiation oncologist with the support of the radiation oncology nurse; other institutions may administer 90Y Zevalin in nuclear medicine.

The radiation oncology nurse monitors the treatment room for contamination after treatment and prepares the room for future administration. Nurses in hematology/oncology and/or in radiation oncology provide discharge instructions and coordinate and administer weekly follow-up for approximately three months to monitor status and blood counts.

The treatment team must establish a clear treatment algorithm and train all team members in the sequence of the regimen and their roles at each step. Communication, education, and coordination are essential in establishing and implementing a treatment for RIT with Zevalin.