Premedication With Antiemetic Improves Length of Stay and Readmissions for a Liver Cancer Procedure

Including an antiemetic in the preprocedure medications for patients with liver cancer undergoing drug eluting bead chemoembolization (DEB TACE) can shorten hospital stays and reduce the chance for readmission due to complications. These findings were reported in a poster presentation at the World Conference on Interventional Oncology.1

DEB TACE is a minimally invasive interventional radiology procedure that uses of drug-coated beads to deliver chemotherapy locally to restrict the blood supply to a tumor, explained Abouelmagd Makramalla, MD, principal investigator for this study, assistant professor of interventional radiology at the University of Cincinnati (UC) College of Medicine and a UC Health interventional radiologist. Makramalla is working in collaboration with Ross Ristagno, MD, assistant professor at the UC College of Medicine and interventional radiology section chief.

A common side effect of DEB TACE is postembolization syndrome (PES), which causes fever, nausea and vomiting, and pain. PES usually occurs within the first 72 hours after DEB TACE; symptoms then begin to subside after 72 hours. Standard practice is to hospitalize the patient for 1 to 2 days for observation. In this study, the researchers were investigating whether adding fosaprepitant, which prevents chemotherapy-induced nausea and vomiting, to the medication regimen prior to DEB TACE treatment would allow for the procedure to be performed on an outpatient basis and prevent hospital readmission for PES.

Using the patient database from the University of Cincinnati, researchers reviewed all patients with liver cancer who had undergone DEB TACE over a 23-month period. Their study sample included 113 consecutive procedures performed in 71 patients.

All the sample patients had received premedication with dexamethasone and fosaprepitant. Postprocedural antiemetics and painkillers were also prescribed as needed. Discharge medications included antiemetics, analgesics, and an antibiotic.

"Of the 113 DEB TACE procedures, only 5 patients [4.4%], were admitted for PES," Makramalla reported. In this study, 108 procedures (96.4%) were successfully performed without the development of PES that required hospital readmission.

"These findings suggest that outpatient DEB TACE could be possible with premedication and a low incidence of hospital readmission for PES, Makramalla said. Patients would be allowed to recover more comfortably in their homes and save time and money for both the patients and the hospital. However, larger studies are needed to determine if this could become a standard pretreatment regimen, he noted.

Reference

1. University of Cincinnati Academic Health Center. Pre-procedure medication regimen could lead to less hospital time for liver cancer patients [news release]. EurekAlert! web site. http://www.eurekalert.org/pub_releases/2016-06/uoca-pmr060916.php. June 9, 2016. Accessed June 28, 2016.

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