• Reference Number: HEY-637/2020
• Departments: Nuclear Medicine
• Last Updated: 29 May 2020

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is Radium-223 Dichloride (Xofigo)?

Radium-223 Dichloride (also known as “radium”) is a radioactive material which is used to treat the spread of some cancers to the bones. Radium is normally given as a course of up to six intravenous injections, each given four weeks apart.

Why do I need Radium-223 Treatment?

When radium is injected into the bloodstream, it is absorbed by your bones and delivers a dose of radiation to the diseased areas. This may help to control pain caused by cancer which has spread to the bones and can slow down the progress of the disease.

Can there be any complications or risks?

Some patients find that the pain gets a bit worse before it gets better. If this does happen, the pain can be managed by pain medications including paracetamol. In addition, if it becomes unmanageable contact your doctor and discuss the options that may be available to you.

The most common side-effects after treatment with radium include:

• Diarrhoea
• Nausea (feeling sick)
• Vomiting
• Dehydration (Please drink 1 to 1.5 litres of fluids per day excluding tea and coffee)

At your hospital clinic appointment, your doctor will give you a prescription for medication which will help relieve these side effects if they do occur.

The radiation which attacks the cancer cells in the bone may also cause some temporary damage to your bone marrow, which may result in slower blood cell production. This may lead to the following side effects:

• Low white cell count which may make you susceptible to infection
• Drop in red blood cells causing anaemia, leading to tiredness
• Drop in platelets causing a tendency to bruising and bleeding

If you develop any of the following symptoms, contact your doctor immediately:

• Any unusual bruising.
• More bleeding than usual after an injury.
• Fever (a high temperature).
• If you seem to be catching a lot of colds or getting other infections.
• Symptoms of pain, swelling or numbness of the jaw, a “heavy jaw” feeling or loosening of a tooth.

How do I prepare for the treatment?

Share the information in this leaflet with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this treatment.

There is some information which we need in advance. This is so that we can plan your treatment and make sure that you are as comfortable as possible during your visit. Please advise if:

• You have any problems with controlling your bowels or bladder, for example, if you wear pads or have a catheter. Since some of the radioactive material will leave your body in your urine and faeces, we need to know of any problems as soon as possible so we can give you the right advice.
• You need a wheelchair or a stretcher. If we know this in advance we can try to make you as comfortable as possible during your visit.
• Your home has a septic tank and when it is due for emptying or maintenance. This is because some of the radium will end up in the tank and we need to make sure it is safe for anybody working on the tank.

You may eat and drink as normal before, during and after the treatment. If you normally take any other medicines please bring these with you including medicines to control your pain. When you arrive in the department, you will be asked to drink 2 – 3 glasses of water. There is no other preparation needed.

Treatment with radium can affect your fertility and may make you sterile. If you plan to have a family at a later date you should discuss this with your hospital doctor before treatment begins.

Can I bring someone with me to the appointment?

You are welcome to bring someone with you when you come for your treatment but it is very important that you do not bring anyone under the age of 18 or anyone who is or might be pregnant.

What will happen on the day of the treatment?

The treatment will be given in the Nuclear Medicine Department at Castle Hill Hospital.

Before we can give you the radium, a member of staff, normally a Medical Physicist will discuss the procedure with you. They will ask questions about you, your life and your family. This is to make sure that it will be safe for you to have the treatment and so that we can give you the right advice about radiation protection after your treatment. They will also explain the protection advice and can answer any questions you or your family may have about the treatment.

Once both you and the member of staff are happy that radium is right for you, a cannula (needle) will be inserted into a vein, usually in your arm. This normally only takes a few minutes and is similar to having a blood test. Please let us know if you have problems with needles or are nervous about this as there may be things we can do to make it easier for you.

Once the cannula is in place, it will be tested to make sure it works properly and then the radium will be given through the cannula. This should normally only take a few minutes and you should not feel any pain from the injection.

What precautions do I need to follow after the treatment?

To protect others from the radium that is excreted from your body in the weeks following your treatment, you will need to be extra careful with bathroom hygiene (e.g. flushing the toilet twice and washing your hands thoroughly).  To avoid splashing, please sit on the toilet rather than standing and wipe up any spills immediately. If you use pads or have a catheter bag we will discuss with you how to manage and dispose of these items.

You can have sexual relations from 1 week after each injection of radium, but you must use effective barrier contraceptive methods (e.g. condoms) during treatment and until six months after your last injection of radium.

You will be given a treatment record sheet after you have received the radium which will contain details of what treatment you have had and the radiation precautions you need to follow.  Please carry this sheet with you until the date you will be told when you attend.

If you have any medical / dental appointments or are admitted to hospital during this time, please show the sheet to the healthcare professional dealing with you.  This is especially important if you fall, develop a fracture or need any surgical treatment, as the doctors may need to take extra care because of the radioactivity in your bones.

It is important that you let the people close to you know that you have had this treatment so that they can tell the people who care for you. If you die in the months immediately after treatment, there may need to be a delay before your body can be buried, cremated or undergo a post-mortem examination.

What about my children or grandchildren – can I see them after the treatment?

If you can follow the precautions regarding hygiene, it will be safe to see your children after your treatment. Providing you follow these precautions there is no need to be concerned.

What happens afterwards?

Approximately two weeks after your treatment you need to have a blood test and see your doctor in the Oncology Clinic (or be reviewed by telephone) to make sure it is safe for you to have your next injection.  If you have not already got an appointment, please call the doctor’s secretary on the telephone number provided to you previously.

Very occasionally, patients who have had this treatment have triggered radiation detectors at airports and ferry terminals up to three months after treatment.  In all of the cases that we have been aware, the patient has been allowed to travel once the authorities have been made aware of the therapy.  If you are planning to travel abroad any time up to 3 months after completing radium treatment, we advise that you keep your treatment record sheet and take it with you.

Should you require further advice regarding the issues contained in this leaflet, please contact the Nuclear Medicine Department on telephone number (01482) 622125.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.