Congress Abstracts 2003

52

WHAT’S OLD IS NEW AGAIN: PATIENTS RECEIVING HEPATIC INTRA-ARTERIAL CHEMOTHERAPY. Diane Barber Fedricker, RN, ANP, BC, AOCN^®, M.D. Anderson Cancer Center, Houston, TX.

Hepatocellular carcinoma (HCC) ranks as the eighth most common cancer in the world. Although rare in Canada and the United States, the incident rate of HCC in the United States has increased by 70% within the past two decades. Generally, the most frequent causes of malignant hepatic disease in the United States are metastases from primary tumors of the gastrointestinal tract, breast, and lung. Surgical resection and systemic chemotherapy are the standard treatments for this disease. However, surgery is not an option for patients with advanced disease, and the response rate from systemic chemotherapy remains low. An alternative therapy for patients with HCC or metastatic liver cancer is hepatic intra-arterial chemotherapy (HAI). HAI chemotherapy is the infusion of a chemotherapeutic drug through the hepatic artery directly into the liver. This method allows a high total body clearance and hepatic extraction, so as to generate high hepatic and low systemic exposures. Several methods are used to deliver HAI chemotherapy: Percutaneous arterial catheters, implanted arterial ports, or an implanted arterial infusion pump. Our center uses the percutaneous arterial catheters. The catheter is placed percutaneously via a femoral approach by the interventional radiologist. A radionucleotide flow study is performed after placement to verify hepatic perfusion. Once the placement is verified, the catheter is connected to an external pump for HAI chemotherapy administration. Patients are placed on bed rest while the HAI catheter is in place. Intra-arterial or peripheral heparin is administered to maintain therapeutic anticoagulation to prevent thrombus formation. Once the HAI chemotherapy is complete, the HAI catheter is removed. Side effects most commonly reported by patients receiving HAI chemotherapy include nausea, vomiting, and gastritis. Catheter displacement and hepatotoxicity are the major complications associated with HAI therapy. Nursing implications for patients receiving HAI therapy include nursing assessment for sign/symptoms of HAI catheter displacement and diligent daily monitoring of liver function tests and activated partial thromboplastin time. Another component of the oncology nurse’s role is teaching patients and their families about this unique procedure, the chemotherapy, potential side effects, possible complications, information regarding follow up and insurance coverage, and referral to social services.