City of Hope is offering a way station between hospital and home to patients with thyroid cancer who have been treated with radioactive iodine.
Physicians provide radioactive iodine therapy along with surgery to fight thyroid cancer — a treatment offering patients a five-year survival rate of 97 percent, according to the American Cancer Society.
However, swallowing radioactive iodine — known as I-131 — leaves patients radioactive for a few days after treatment. To reduce potential exposure risk to family members and others, City of Hope has established an apartment in Hope Village so patients can spend a brief time alone until the radiation has dissipated.
“This is a tremendous opportunity,” said Chuck Pickering, director and chief safety officer of the Occupational Safety & Health Department, who helped start the program. “I know of no other hospital in the country that offers something similar.”
When Pickering joined City of Hope in 2005, thyroid cancer patients often stayed in the hospital for a few days after radiation treatment even though they were not sick, he recalled. “There was no reason for most of them to be in a hospital except to isolate them,” he said.
Now that has changed.
A Hope Village apartment is an ideal way station, Pickering said, because of its “thick concrete walls that form an effective barrier to stop radiation.” Even better, he said, apartments within a unit are offset, minimizing adjoining walls. Renovators installed radiation-blocking lead sheeting on adjoining walls.
In 2007, 10 patients used the apartment as a comfortable place to “cool down” after I-131 treatment.
Because the thyroid gland naturally accumulates iodine, radioactive iodine acts as a sort of magic bullet targeting cancer cells that may linger after surgeons remove the gland. After a patient swallows a I-131 capsule, any lingering thyroid cells absorb radioactivity, while most is excreted in the urine and, to a lesser extent, in fluids like sweat and saliva.
About half of the unstable radioisotope decays within a week, making patients an exposure risk for only a short time. Most go home after three days.
Patients live alone during their stay. They have a mountain view from a fenced-in patio but cannot leave the area. Friends can visit an adjacent garden but are advised to stay about six feet away to avoid radiation exposure. Patients can prepare their own food or order take-out; a TV/DVD player and Internet connection help pass the time.
Once the patient leaves, a team from Occupational Safety & Health carefully inspects the room and collects any contaminated items before housekeeping prepares the room for the next visitor.
Children with thyroid cancer are also treated with I-131, but pediatric patients have not yet used the apartment. Pickering noted that the two beds in the room are about six feet apart. “We could have a parent and child stay in same room, while keeping the parent safe. That is something I really like,” he said.
While patients treated with radioactivity once remained hospitalized, the trend now is to release them immediately.
“It is becoming increasingly common to treat thyroid cancer patients with I-131 therapy on an outpatient basis at multiple hospitals throughout the country with no hospitalization or supervised stay whatsoever,” said Dave Yamauchi, M.D., director of nuclear medicine.
About 33,550 cases of thyroid cancer were diagnosed in the United States in 2007, according to American Cancer Society estimates.