Episode 285: Transarterial Chemoembolization: The Oncology Nurse's Role

"I think oftentimes people think this is just a radiology procedure that is rather benign. That's really the role of the oncology nurse, just to be [an educator], support, emotional support, and a coach," Lisa Parks, MS, APRN-CNP, ANP-BC, nurse practitioner in hepatobiliary surgery at The James Cancer Hospital and Solove Research Institute at The Ohio State University Comprehensive Cancer Center in Columbus, Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what oncology nurses should know about transarterial chemoembolization administration and their role surrounding that procedure. This episode is part of a series about non-IV chemotherapy administration; the others are linked below. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to transarterial chemoembolization. Episode Notes The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities . Oncology Nursing Podcast episodes about non-IV chemotherapy administration: Episode 271: Intraventricular and Intrathecal Administration: The Oncology Nurse's Role Episode 265: Intravesical Administration: The Oncology Nurse's Role Episode 252: Intraperitoneal Administration: The Oncology Nurse's Role Oncology Nursing Forum articles: Symptom Distress in Patients With Hepatocellular Carcinoma Toward the End of Life Living With Hepatocellular Carcinoma Near the End of Life: Family Caregivers' Perspectives ONS Chapters To discuss the information in this episode with other oncology nurses, visit the ONS Communities . To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library . To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org . Highlights From Today's Episode "So, TACE was commonly used to treat liver metastatic cancers, primarily metastatic colon cancer, until research showed that some of these cancers were not responding to TACE. Therefore, it is no longer really used in metastatic colon cancer. TACE is used in hepatocellular cancer. It also was used more than 10 years ago to treat metastatic neuroendocrine cancers. But recent research has showed that neuroendocrine cancers respond to this embolization without the use of chemotherapy. By eliminating chemotherapy, we also eliminate the potential for side effects." TS 3:29 "TACE, or TAE, is usually completed more than once in the course of a patient's treatment. Depending on the tumor burden of the liver, the procedure can be segmentally completed on a liver lobe, or you can do the procedure on the right lobe and then follow-up treatment in about six weeks in the left lobe." TS 5:45 "This is something that isn't even really taught in medical school. So it's really important to understand that even though this is a postprocedural side effect, there are certain things that you have to be aware of. So, the most common side effect that you will see is right upper-quadrant pain, and this is very common. And if the left side of the liver has received the therapy, this pain can radiate to the epigastric area and the patient will describe it as chest pain. And when you have the patient point to that area where he's having pain, it's often epigastric and it's just a referred pain, it's not cardiac pain, typically. You can get a EKG and troponin, but those are almost always negative and it's just really part of this embolization syndrome." TS 14:30 "As far as what the oncology nurse needs to really be aware of pre-TACE or pre-TAE, I just want to emphasize the importance of patient education. The patient and their family need to understand again, it's not a surgery, it's a radiology procedure, and that the patient is going to have abdominal pain and nausea and vomiting that will last for several weeks and that is why they are not kept in the hospital for three weeks until these symptoms dissipate. Oftentimes these symptoms will be present until they get reimaged at the medical oncologist and then it's time for them to come back and maybe get another phase of their procedure that they are supposed to have as part of their treatment plan." TS 17:44 "I do want to let you know, though, that patients that have a significant spike of their transaminases over 1,000, those patients are of great concern of going into liver failure. So, the nurses need to let the patient know that they will be monitored and kept in the hospital until we start to see a downtrend in those transaminases before they will be discharged." TS 19:48 "As an oncology nurse and medical oncology, [it's] education, education, education. Also being able to triage these patients on the phone, talking them through how to keep themselves hydrated. . . . So I just think it's really a coaching job of the oncology nurse. A lot of reassurance, a lot of suggestions on how to get through this very uncomfortable difficult procedure." TS 21:16 "I want it to be clear that if you're doing local regional therapy, TACE or TAE, this is considered a palliative procedure. You are not going to get a cure with this treatment. In this situation, neuroendocrine carcinoma, it's already metastatic if you're treating the liver. And with hepatocellular, again, it's still palliative because you're not doing a surgical resection on this patient. And every TACE experience for every patient, I've had patients that've and I've had six of these procedures, every experience they get is different." TS 28:11 "When the patient comes back to our floor after having the treatment, it's just very important for those nurses to know the 'abnormal normal,' to know that some of the things that they're seeing, the hypertension, the severe pain, the severe nausea, is actually normal and the provider will work with them to try to come up with a regimen that will make the patient as comfortable as possible." TS 33:22