I'm curious about isle 2 patients

luvbug9956 · Aug 18, 2007

There is a big difference between chemotherapy and biotherapy in regard to both toxicities and method of action. I am 26 and have worked oncology for 3 years. There is no definitive data on whether nurses working with chemotherapy have a higher risk of fertility issues. However, in my facility, once you become pregnant, you have the option to not hang chemo. Many of the nurses that I have worked with over the years have had normal, healthy pregnancies; some have gone through IVF to get pregnant. Whether or not this has anything to do with hanging chemo is unknown. To protect myself, I always wear my PPE...gown and double gloves. There are also different levels of risk...at my facility, we do not mix the agents, we just hang so there is much less risk of exposure.

Sailingshoes · Aug 18, 2007

I work in medical oncology and I do hang chemotherapy with PPE. Also we use an enclosed tubing system called Phas-seal (spell?), that prevents leaking or aerosole contamination. I do not have to mix chemo and I feel safe in what I do perform. Perhaps you could speak with your oncology pharmacist for more detailed information regarding risk. Also, I think with newer procedures for mixing, the phas-seal and wearing PPE, chemo exposure is not the risk that it was 20 yrs ago.

caroladybelle, BSN, RN · Aug 18, 2007

Hello nurses..
First I must say that I am a new grad and I have no experience with these types of patients. All through school, I've known I didn't want to work with chemotherapy or cancer patients b/c it's very difficult for me. When I interviewed for this position, it was for an ICU and not a specialized area that involved oncology. I love the hospital where I'm at and am so happy to be working here, but I am so uneasy about this unit b/c of the chemo. It was after I took the position that I found out I was being placed on this unit. The unit itself and the people are AMAZING, but the chemo is what worries me. I want to talk to other more experienced nurses who really know about this stuff and who can offer their advice and direction. Other nurses have said to me that if I want to have children soon, I shouldn't work on this unit. I have a friend who just found out she is sterile and the doctor told her it was more than likely caused by working around chemotherapy. She is an oncology nurse and is 37. This of course could be coincidence, but it worries me being that I am 38 and am looking to have children within the next few years. On my unit, we don't hang "chemotherapy", but we do hang bio chemotherapy. I still am confused about the difference there. One is more toxic than the other? If you have any advice for me, please offer it. It's very appreciated.

Are you referring to High Dose IL-2?

Mnay ICU nurse do have to deal oncology patients. While many may have surgery and bounce to the ICU, there are also those undiagnosed or newly diagnosed patients that end up in ICU due to lifethreatening effects of the cancer. Tumor Lysis may result in needing CVVHD, Spinal Cord compression and pulmonary leukostasis may require vents, malignant pleural effusions/superior vena cava syndrome may require CTs or pericardial windows, esophageal cancers may need a complex resection of the esophagus, stomach and duodenum - an open chest procedure with 4 chest tubes. And the list goes on.

Some ICU nurses give onco nurses attitude during transfers....the "but they will probably die because they have CANCER" attitude. But my 23 year old leukemic that needs to be vented d/t pulmonary leukostasis may more likely to live than the 70 year old heart attack patient or aneurysm patient. Estimates vary - between 70-75% of cancer patients will go on to live a normal life span after being treated.

Chemotherapy and biotherapy vary. Sometimes the differences to the layperson's eye are subtle. Chemotherapy tend to be agents that kill certain cells, by damaging them, damaging cancer cells' DNA, keeping them from effectively reproducing. They often also damage some healthy cells, also. Biotherapy generally helps the body's processes to eliminate the cancer, prevent it from reproducing, mobilizing the body itself and its immune system to go against the cancer. Many of the newer targetted (anti-EGFR, anti-VEGF drugs), monoclonal antibodies and of course interleukins are considered biotherapy.

Many chemotherapies cause bone marrow suppression and anemia, nausea, GI problems, hair loss etc. Biotherapies tend to have more allergic/hypersensitivity reactions, less anemia, and more allergy type side effects. In at least one, the patients get a rash that resembles acne, that cannot be treated with acne meds. And unusually, the worse the pt's rash, the more effective the med is against cancer.

As to toxicities between the two, it is relative. Most people think that chemotherapy is more overall destructive. However, consider that there are many drugs that are considered hazardous, that nurses handle carelessly. Ganciclovir ( a common antiviral for CMV) is notoriously hazardous to childbearing nurses and been connected to cases of cancer, plus linked to retinal detachments in patients, yet many people prime tubing openly, and get the drug on their hands.

If you follow the guidelines per OSHA/ONS regarding handling chemo, there should be no danger to fertility. However, places are not careful and many nurses are not careful and do not adhere strictly to policy. In the past, I know nurses that handled chemo that miscarried. But they were either mixing the drug (should be done by pharmacy, not nursing, and under a biohood), or free priming the tubing with the chemo instead of appropriate neutral fluid (NS/D5W) thus, were inhaling/exposing themselves to aerosolized chemo. I would be hesitant about mixing chemo, though if I were pregnant/thinking about pregnancy even with a bio hood.

HDIL2 (high dose interleukin 2) often requires single or double vasopressors be used. As such, they need to be on a Tele unit or ICU, not on most nontele onco units. Sometimes it is done on specialty leukemia units/BMT since they frequently have tele and a better nurse per pt ratio. The drug is given 14 doses - one each 8 hours. The drug often sends the patient temporarily into some renal failure and third spacing w/fluid overload. Their pressure drops and may need single or double vasopressors. We always placed a triple lumen central line - for if they required double pressors - they are too edematous by the time that they need pressors, to find an IV site. They turn puffy, get a bright red flush all over, itch (no steriods can be used - whereas steriods are frequently used with standard chemo), and run fevers. I have had 2 patients that had major MIs on the drug. They also are very emotional to the point of dangerous rage, may have severe diarrhea. It is one of the only effective treatments for met. melanoma. It was also used as one of the only treatments for met. renal cell cancer - there is now a better tolerated drug for that. HDIL2 is only available in limited centers due to the requirements and dangers of the drug.

czyja, MSN, RN · Aug 19, 2007

I have a friend who just found out she is sterile and the doctor told her it was more than likely caused by working around chemotherapy. She is an oncology nurse and is 37. This of course could be coincidence, but it worries me being that I am 38 and am looking to have children within the next few years.

As a disclaimer, I am not a nurse, but a cancer biologist heading into nursing. In my work I use 5-FU and other cytostatic agents that you nurses administer to your patients. I work with chemo drugs in a biosafety cabinet (while double gloved) and I feel quite safe.

Caroladybelle gives a lovely concise and accurate summary of biotherapy and chemotherapy. I suspect her patients are deeply appreciative of her and if they aint they oughtta be! She also points to a important fact - if you handle the agents wearing full protection and if they are administered in sealed systems then the danger to you should be quite minimal. Prototcols for handling toxic agents are established in many workplaces because they are effective. Follow them religiously. Never handle an drug or chemical that you have not been trained to handle.

The doc who told your friend that her infertility is the result of administering chemo must have went to med school in the pre-scientific era. Either that or he must be psychic. Correlation is not the same thing as causation.

CityKat, BSN, RN · Aug 19, 2007

Are you referring to High Dose IL-2?
Mnay ICU nurse do have to deal oncology patients. While many may have surgery and bounce to the ICU, there are also those undiagnosed or newly diagnosed patients that end up in ICU due to lifethreatening effects of the cancer. Tumor Lysis may result in needing CVVHD, Spinal Cord compression and pulmonary leukostasis may require vents, malignant pleural effusions/superior vena cava syndrome may require CTs or pericardial windows, esophageal cancers may need a complex resection of the esophagus, stomach and duodenum - an open chest procedure with 4 chest tubes. And the list goes on.
Some ICU nurses give onco nurses attitude during transfers....the "but they will probably die because they have CANCER" attitude. But my 23 year old leukemic that needs to be vented d/t pulmonary leukostasis may more likely to live than the 70 year old heart attack patient or aneurysm patient. Estimates vary - between 70-75% of cancer patients will go on to live a normal life span after being treated.
Chemotherapy and biotherapy vary. Sometimes the differences to the layperson's eye are subtle. Chemotherapy tend to be agents that kill certain cells, by damaging them, damaging cancer cells' DNA, keeping them from effectively reproducing. They often also damage some healthy cells, also. Biotherapy generally helps the body's processes to eliminate the cancer, prevent it from reproducing, mobilizing the body itself and its immune system to go against the cancer. Many of the newer targetted (anti-EGFR, anti-VEGF drugs), monoclonal antibodies and of course interleukins are considered biotherapy.
Many chemotherapies cause bone marrow suppression and anemia, nausea, GI problems, hair loss etc. Biotherapies tend to have more allergic/hypersensitivity reactions, less anemia, and more allergy type side effects. In at least one, the patients get a rash that resembles acne, that cannot be treated with acne meds. And unusually, the worse the pt's rash, the more effective the med is against cancer.
As to toxicities between the two, it is relative. Most people think that chemotherapy is more overall destructive. However, consider that there are many drugs that are considered hazardous, that nurses handle carelessly. Ganciclovir ( a common antiviral for CMV) is notoriously hazardous to childbearing nurses and been connected to cases of cancer, plus linked to retinal detachments in patients, yet many people prime tubing openly, and get the drug on their hands.
If you follow the guidelines per OSHA/ONS regarding handling chemo, there should be no danger to fertility. However, places are not careful and many nurses are not careful and do not adhere strictly to policy. In the past, I know nurses that handled chemo that miscarried. But they were either mixing the drug (should be done by pharmacy, not nursing, and under a biohood), or free priming the tubing with the chemo instead of appropriate neutral fluid (NS/D5W) thus, were inhaling/exposing themselves to aerosolized chemo. I would be hesitant about mixing chemo, though if I were pregnant/thinking about pregnancy even with a bio hood.
HDIL2 (high dose interleukin 2) often requires single or double vasopressors be used. As such, they need to be on a Tele unit or ICU, not on most nontele onco units. Sometimes it is done on specialty leukemia units/BMT since they frequently have tele and a better nurse per pt ratio. The drug is given 14 doses - one each 8 hours. The drug often sends the patient temporarily into some renal failure and third spacing w/fluid overload. Their pressure drops and may need single or double vasopressors. We always placed a triple lumen central line - for if they required double pressors - they are too edematous by the time that they need pressors, to find an IV site. They turn puffy, get a bright red flush all over, itch (no steriods can be used - whereas steriods are frequently used with standard chemo), and run fevers. I have had 2 patients that had major MIs on the drug. They also are very emotional to the point of dangerous rage, may have severe diarrhea. It is one of the only effective treatments for met. melanoma. It was also used as one of the only treatments for met. renal cell cancer - there is now a better tolerated drug for that. HDIL2 is only available in limited centers due to the requirements and dangers of the drug.

Caroladybelle, thank you so much for your time and knowledge on this!! Your information was extremely detailed and has given me reassurance with this. I love my unit, the patients and the people I work with, so this is very reassuring for me. I work on a step down ICU for oncology patients and we only use the bio chemo and our patients have met melanoma.

caroladybelle, BSN, RN · Aug 19, 2007

Thank you for the kind words.

HDIL2 usually is given over one week - then there is a one week break - and then given again on week three. If it is effective and the patient tolerates the drug, they go on a low dose IL2 protocol....a much more well tolerated treatment.

You will find that many patients never get all 14 HDIL2 doses in a cycle, due to toxicities; Such as BP that cannot stabilized on pressors, GI toxicity (SEVERE Diarrhea), Neuro disturbances or cardiac problems. Patients on HDIL2 may void only once per day - a small amount - very concentrated. They often have a brief renal failure d/t capillary leak and serious third spacing of fluid - it reverses outt when the drug is stopped.

What sad is this drug is often the only chance for these patients. They will get upset if you omit a dose because of excess toxicity (the MD orders this as needed), because they know the need to get as many as possible. I have had them yell at me about omiting doses. One of my MI cases - we had omitted two doses due noncardiac toxicity, and he needed to be cleared by the MD before proceeding. He yelled at me....an hour later, I came in as he went into having a serious MI....which ruled out anymore doses.

Is this a teaching hospital? Given the need for close supervision, being in a teaching hospital is a plus.

CityKat, BSN, RN · Aug 28, 2007

Thank you for the kind words.
HDIL2 usually is given over one week - then there is a one week break - and then given again on week three. If it is effective and the patient tolerates the drug, they go on a low dose IL2 protocol....a much more well tolerated treatment.
You will find that many patients never get all 14 HDIL2 doses in a cycle, due to toxicities; Such as BP that cannot stabilized on pressors, GI toxicity (SEVERE Diarrhea), Neuro disturbances or cardiac problems. Patients on HDIL2 may void only once per day - a small amount - very concentrated. They often have a brief renal failure d/t capillary leak and serious third spacing of fluid - it reverses outt when the drug is stopped.
What sad is this drug is often the only chance for these patients. They will get upset if you omit a dose because of excess toxicity (the MD orders this as needed), because they know the need to get as many as possible. I have had them yell at me about omiting doses. One of my MI cases - we had omitted two doses due noncardiac toxicity, and he needed to be cleared by the MD before proceeding. He yelled at me....an hour later, I came in as he went into having a serious MI....which ruled out anymore doses.
Is this a teaching hospital? Given the need for close supervision, being in a teaching hospital is a plus.

Hi...sorry it took awhile to answer you. I've been busy. This is a teaching hospital and there is close supervision which is very good. I talked to the oncology NP and the oncologist about my concerns. They were so amazing and helpful. They walked me through everything and explained it thoroughly. I definitely feel much better after talking to you and them. Thanks so much:)