"I think that as oncology nurses, we need to keep ourselves really educated and up to date with these new therapies, because I honestly feel like we still haven't really seen the long-term effects of this treatment," ONS member 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, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about recognizing hepatic complications and understanding the basics of its symptom management strategies. This episode is part of a series on cancer symptom management basics; 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 in cancer symptom management basics and hepatic complications.

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:

• • Episode 269: Cancer Symptom Management Basics: Gastrointestinal Complications

  • Episode 256: Cancer Symptom Management Basics: Hematologic Complications

  • Episode 250: Cancer Symptom Management Basics: Dermatologic Complications

  • Episode 244: Cancer Symptom Management Basics: Cardiovascular Complications

• ONS Voice article: To Prevent Hepatotoxicity, Monitor Liver Function During Cancer Treatment

• Clinical Journal of Oncology Nursing articles:

• • Checkpoint Inhibitors: Common Immune-Related Adverse Events and Their Management

  • Identification and Management: Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease Related to Hematopoietic Stem Cell Transplantation

  • Use of Hepatic Artery Infusion Pumps in the Treatment of Hepatic Metastases

• ONS courses:

• • ONS/ONCC Chemotherapy Immunotherapy Certificate Course

  • ONS/ONCC Radiation Therapy Certificate Course

• ONS books:

• • Cancer Basics (third edition)https://www.ons.org/books/cancer-basics-third-edition

  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)

• • Manual for Radiation Oncology Nursing Practice and Education (fifth edition)

  • Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition)

• American Gastroenterological Association

• American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy

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 [email protected]

Highlights From Today's Episode

"There is something called chemotherapy-induced liver injury. What the chemotherapy does is it has a direct hepatotoxic effect on the hepatocytes themselves. If you have preexisting liver disease such as cirrhosis, it can lead to very severe hepatotoxicity because the function of the liver is already compromised by the damage previously done to it." TS 3:47

"The American Gastroenterological Association published guidelines on the management of HBV reactivation for patients during immunosuppressive treatment, and they basically do recommend any patients with a hep B virus that they receive antiviral prophylaxis to prevent this reactivation from occurring. Also in 2008, the CDC recommended universal HBV screening for all patients before administering chemotherapy. This one you see most commonly in patients who receive chemotherapy for a hematological cancer following hemopoietic stem cell transplantation." TS 14:19

"One of the most common things that I've encountered in my practice is that there seems to be a thought that once hepatic complications are identified, there is treatment for this, and in these patients, we can't reverse liver injury. Really, what we offer these patients is supportive care. These patients often can decompensate really quickly, and often these patients may require being transferred to the intensive care unit and it's not because there's any intervention that we're going to do. But I think it's very frustrating for nurses to see these severe liver injuries, that are life threatening, and not to be able to do anything about it." TS 19:06