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appendix 17.4 radium-223 patient handouts

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This is an injection of the radioactive material radium 223, and will be administered in the Nuclear Medicine Department at the Huntsman.  
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Radium 223 (Xofigo®) is given as an injection into a vein every 28 days for 6 planned doses. Your blood counts must be checked a few days prior to each dose to ensure the next dose is safe to give.  
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It is used to treat prostate cancer that is not responding to treatments that lower your testosterone and has spread to your bones.  
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It is very important for you to stay hydrated while receiving this medication.  
Contact the clinic if you are experiencing dehydration, decreased urine output, or decreased ability to drink fluids.  
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Most common side effects include:
10 o o o Nausea Diarrhea Vomiting Swelling of the arms or legs (peripheral edema)
Low blood cell counts (including your infection fighting cells, hemoglobin, and platelets)
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There are medications that may be prescribed to treat some of the side effects of radium 223. If you experience any intolerable side effects, please contact the Radiation Oncology Front Desk at (801) 581-2396 and ask to speak to a nurse.  
You can also call the Nuclear Medicine Clinic at (801) 581-2370 or your study coordinator. If it is an emergency please dial 911.  
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Follow good hygiene practices to prevent infections. Notify the clinic if you experience bleeding or signs of an infection. Examples of infection include a fever of 100.5°F or higher, chills, or cough.  
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Use caution to keep body fluids from coming into contact with family members and caregivers for at least one week following each treatment.  
Clothing soiled with fecal matter or urine must be washed immediately o and separately from other clothing.  
Caregivers should wear gloves and barrier gowns when handling bodily o fluids to avoid contamination. Caregivers must wash hands after handing body fluids.  
ok Use the same toilet each time you use the bathroom in your home. Sit down to urinate. Flush the toilet with the lid down three times after each use. Wash your hands thoroughly using the bathroom.  
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If you are sexually active with a female partner of childbearing potential, use a latex condom and a second method of birth control during treatment AND for 6 months after stopping this medication.  
The Nuclear Medicine Department is located on the 3 rd floor of the Huntsman Cancer Hospital  
  
  
Principal Investigator: Jonathan Tward, MD, PhD
Revision Date: 11/4/2015 Owner: Delynn Strate, Manger Nuclear Medicine Patient Instruction for Xofigo Therapy University of Utah Healthcare Huntsman Cancer Institute Please follow the precautions listed below after the Xofigo dose is given.  
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Be sure you keep your blood cell count monitoring appointments and report to a healthcare provider any signs of low blood cell counts (such as shortness of breath and tiredness in the case of anemia), and report any signs of bleeding (such as bruising) or infection (such as fever).  
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Stay well hydrated and report any signs of dehydration, or urinary or kidney problems.  
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There are no restrictions regarding contact with any other people after receiving a Xofigo dose.  
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Bathroom hygiene is important. Radioactivity is present in urine and feces for some time after treatment. Be sure to practice good personal hygiene while on treatment with Xofigo and for at least 1 week after the last injection. After going to the bathroom, be sure to wash your hands thoroughly and flush the toilet several times. Promptly clean up spilled bodily waste, wearing gloves when you clean. Dispose of gloves as trash and place in plastic bags to prevent accidental access. Wash your hands when you are finished. If bodily waste gets into clothing, promptly wash it separately from other laundry.  
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Use condoms and make sure female partners who can have children use highly effective birth control methods during and for a minimum of 6 months after treatment with Xofigo.  
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The most common side effects of Xofigo include nausea, diarrhea, vomiting, swelling of the arms or legs (peripheral edema), and low blood cell counts. Tell your healthcare provider if you have any side effects that bother you or do not go away.  
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If you have any questions please call the Nuclear Medicine Clinic at (801) 581-  
2370. You can also call the Radiation Oncology Front Desk at (801) 581-2396 and ask to speak to a nurse or contact your study coordinator. If there is an
emergency please dial 911.  
Version Date: 08APR2021 Principal Investigator: Jonathan Tward, MD, PhD
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appendix 17.5 ecog/kps conversion

| ECOG PERFORMANCE STATUS                                                                                                                                       | KARNOFSKY PERFORMANCE STATUS                                                                                                                                     |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 100—Normal, no complaints; no evidence of  disease                                                                                                            |                                                                                                                                                                  |
| 0—Fully active, able to carry on all pre-disease  performance without restriction                                                                             | 90—Able to carry on normal activity; minor signs  or symptoms of disease 80—Normal activity with effort, some signs or  symptoms of disease                      |
| 1—Restricted in physically strenuous activity but  ambulatory and able to carry out work of a light or  sedentary nature, e.g., light house work, office work | 70—Cares for self but unable to carry on normal  activity or to do active work 60—Requires occasional assistance but is able  to care for most of personal needs |
| 2—Ambulatory and capable of all selfcare but unable to  carry out any work activities; up and about more than 50%  of waking hours                            | 50—Requires considerable assistance and  frequent medical care 40—Disabled; requires special care and  assistance                                                |
| 3—Capable of only limited selfcare; confined to bed or  chair more than 50% of waking hours                                                                   | 30—Severely disabled; hospitalization is  indicated although death not imminent 20—Very ill; hospitalization and active  supportive care necessary               |
| 4—Completely disabled; cannot carry on any selfcare;  totally confined to bed or chair                                                                        | 10—Moribund                                                                                                                                                      |
| 5—Dead                                                                                                                                                        | 0—Dead                                                                                                                                                           |  
*Karnofsky D, Burchenal J, The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod C,
ed. Evaluation of Chemotherapeutic Agents. New York, NY: Columbia University Press; 1949:191–205. **Zubrod C, et al. Appraisal of methods for the study of chemotherapy in man: Comparative therapeutic trial of nitrogen mustard and thiophosphoramide. *Journal of Chronic Diseases*; 1960:11:7-33.