Retired nurse Joan Seide, 79, is about to receive another infusion of an experimental drug she hopes will cure her cancer — or at least keep it from spreading.
Lying in bed at City of Hope, she thinks back to 1981, when she was first diagnosed with lung cancer. Doctors removed her upper right lung lobe in a hospital near her Palos Verdes Estates home. She remained cancer free until five years ago, when stage-four cancer returned — in both lungs — and she turned to City of Hope for help.
 Joan Seide, left, talks with nurses Patrah Mack, center, and Chris Krygsman. (Photo by p.cunningham) |
“The only thing they could do was chemotherapy to control it — and they’ve controlled it very well,” she said.
Seide recently enrolled in a phase I clinical trial of a new potential chemotherapy called IT-101. She underwent her first infusions as an outpatient in the Geri & Richard Brawerman Ambulatory Care Center, but now receives them in the new Phase I Unit, inside Unit A. The unit, opened in early October, is specifically dedicated to the needs of patients treated with new, investigational therapies.
She appreciates the unit’s less bustling, more private and intimate atmosphere, and the “supportive nurses with wonderful attitudes” who care for her. “They almost anticipate your questions and your problems,” said Seide. “They’re the way nurses should be.”
Before the Food and Drug Administration approves a drug for public use, it must first go through a rigorous, three-phase testing process in human beings.
“Clinical trials are the only road to progress in improving cancer treatment,” said Seide’s physician, Marianna Koczywas, M.D. “Phase I clinical trials are the early stages of the drug’s development, when the safety and the dosing level are tested in a small number of patients.”
Phase I studies often represent a much-needed option for patients who have not responded well to traditional chemotherapy, or who have had a recurrence of cancer that resisted standard treatmemments. City of Hope currently offers more than 50 of these phase I trials, many of them initiated by City of Hope physicians.
Nurses caring for patients receiving phase I medications must deal with a “different type of intensity,” said Sharon Steingass, R.N., M.S.N., vice president of ambulatory services.
Each protocol requires rigorous monitoring and documentation. Nurses must draw blood at precisely timed intervals to assess how patients are tolerating, absorbing and excreting the drug, and to ensure patients’ safety and the studies’ accuracy.
They must ensure patients are not experiencing complications during the infusions, and collaborate with physicians, pharmacists and protocol nurses to ensure protocols are precisely followed.
“Patients treated with investigational agents undergo frequent monitoring and blood draws, and are closely assessed for potential side effects that might be attributed to the new drugs,” said Joanne Mortimer, M.D., administrative director of phase I programs. “These nurses understand the unique administration requirements and pharmacologic assessment of drug toxicity that are the backbone of phase I treatment.”
Koczywas noted that while the research has been thoroughly tested in laboratory and animal studies, potential side effects cannot be known ahead of time. “That’s why it’s imperative to have a dedicated team of physicians, nurses and scientists to conduct phase I trials in a very controlled setting,” Koczywas added. “We truly appreciate having the new unit and administration support of our research efforts.”
Nurses and other staff in the unit must be particularly empathetic, since many patients may suffer from pain, fatigue and nausea.
Creating a space for the nine-patient Phase I Unit took about a year, said Steingass, from finding the location to hiring and training staff. For now, the unit only accommodates patients with solid tumors, though hospital leaders hope to open it to hematologic malignancies in the future.
Seide said the drug has made her tired, thinned her hair and made her skin “paper thin.” Yet, she is grateful it also seems to be keeping the cancer “in abeyance.”
She also is grateful for City of Hope, she said, marveling at “the kindness of the people who wash the floors, who register you when you come in, who draw your blood. No matter who you come in contact with, they’re so kind. It makes a big difference.”
Seide is also grateful for her husband, Paul. Sitting across from her, he reminisces about their “interesting voyage” of nearly 58 romantic years together, which started on a blind date. He helped keep her going through treatment, as have her two children, four grandchildren and the countless friends made during her 35-year career as a pediatric allergy nurse.
Seide offers another reason for pursuing investigational therapies.
“Because,” she said quietly, brushing away tears, “it’s nice being alive.”
Editor’s note: The Phase I Unit may be reached through ext. 60780.