b'Editors note: This information was provided by VeteranwasprescribedXofigo(radiumRa223 Bayer and was edited for consistency and clarity, butdichloride), an injection used to treat patients with not reported or written, by U.S. Medicine staff.castration-resistantprostatecancer,symptomatic bone metastasis and no known visceral disease. The Our military members are a valuable asset to theprescribing information notes that Xofigo should be security of the nation. For putting their lives on thereceived, used, and administered only by authorized line, they deserve access to the best medical carepersons in designated clinical settings and patients availablebothwhileinserviceandaftertheyshould have their blood counts monitored at base-leave the military. line and prior to every dose of Xofigo. But sometimes barriers to treatment can preventThesecontrolswereputinplacebecausethe them from accessing the care they need.therapy requires precise handling. They were also These barriers are often put in place for all the rightestablished because of outcomes from the phase 3 reasons:BecauseweneedcontrolstoguaranteeALSYMPCA trial, the pivotal trial that established that the right product gets to the right patient at theXofigos clinical effectiveness, 2% of those individ-right time and place. Unfortunately, for patients whouals experienced bone marrow failure, or ongoing are managing complex, chronic diseases and are atpancytopenia, compared to no patients treated with riskforexperiencingpost-traumaticstressdisorderplacebo. As a result, two deaths were attributed to (PTSD)episodes,thesecontrolscanpreventthembone marrow failure. from receiving the treatment they need. In these situa- At the time the Veteran was seen, Zablocki VAMC tions, it is incumbent on all stakeholders in the healthwas not licensed to administer Xofigo. Following system to work together to ensure a patient receivesthepassageofCareintheCommunityNetwork the care they need and deserve in a timely way. (CCN), which directly links VA facilities with com-A recent example of this involved a Veteran frommunity providers to ensure Veterans receive timely, theClementZablockiMilwaukeeVAMC.Thehigh-quality care, the Veterans oncologist decided IMPORTANT SAFETY INFORMATION HematologicalEvaluation:Monitorbloodcounts at baseline and prior to every dose of Xofigo. Prior Warnings and Precautions: to first administering Xofigo, the absolute neutrophil BoneMarrowSuppression:Inthephase3count (ANC) should be 1.5109/L, the platelet count 100109/L,andhemoglobin10g/dL.Priorto ALSYMPCAtrial,2%ofpatientsintheXofigosubsequent administrations, the ANC should be1armexperiencedbonemarrowfailureorongoing109/L and the platelet count 50109/L. Discontinue pancytopenia, compared to no patients treated withXofigo if hematologic values do not recover within 6 to placebo. There were two deaths due to bone marrow8 weeks after the last administration despite receiving failure. For 7 of 13 patients treated with Xofigo bonesupportive caremarrow failure was ongoing at the time of death. Among the 13 patients who experienced bone marrow failure,Concomitant Use With Chemotherapy: Safety and 54% required blood transfusions. Four percent (4%)efficacyofconcomitantchemotherapywithXofigo of patients in the Xofigo arm and 2% in the placebohave not been established. Outside of a clinical trial, arm permanently discontinued therapy due to boneconcomitant use of Xofigo in patients on chemotherapy marrow suppression. In the randomized trial, deathsis not recommended due to the potential for additive related to vascular hemorrhage in association withmyelosuppression.Ifchemotherapy,othersystemic myelosuppression were observed in 1% of Xofigo- radioisotopes,orhemibodyexternalradiotherapy treated patients compared to 0.3% of patients treatedare administered during the treatment period, Xofigo withplacebo.Theincidenceofinfection-relatedshould be discontinueddeaths(2%),seriousinfections(10%),andfebrile neutropenia (1%) was similar for patients treatedIncreased Fractures and Mortality in Combination with Xofigo and placebo. MyelosuppressionnotablyWithAbirateronePlusPrednisone/Prednisolone: thrombocytopenia,neutropenia,pancytopenia,andXofigoisnotrecommendedforuseincombination leukopeniahasbeenreportedinpatientstreatedwith abiraterone acetate plus prednisone/prednisolone with Xofigo.outside of clinical trials. At the primary analysis of the Monitor patients with evidence of compromised bonephase3ERA-223studythatevaluatedconcurrent marrow reserve closely and provide supportive careinitiationofXofigoincombinationwithabiraterone measureswhenclinicallyindicated.Discontinueacetateplusprednisone/prednisolonein806 Xofigoinpatientswhoexperiencelife-threateningasymptomatic or mildly symptomatic mCRPC patients, complicationsdespitesupportivecareforbonean increased incidence of fractures (28.6% vs 11.4%) marrow failure anddeaths(38.5%vs35.5%)havebeenobserved in patients who received Xofigo in combination with'