Staying Up to Date on Management of Tumor Lysis Syndrome With Amy Goodrich, MSN, RN, CRNP

Tumor lysis syndrome (TLS) is a rare, potentially life-threatening oncologic emergency typically associated with chemotherapy-induced tumor cell death in which potassium, phosphate, and nucleic acids are released into the bloodstream. The most effective management strategy is prevention; however, despite appropriate prophylactic measures, approximately 3% to 5% of high-risk patients receiving chemotherapy are affected.

In this interview, Amy Goodrich, MSN, RN, CRNP, a Nurse Practitioner and Research Nursing Manager at the Johns Hopkins Kimmel Cancer Center, discusses a recent educational activity she co-led, Best Practices in the Management of Tumor Lysis Syndrome Associated With Emerging Cancer Therapies

Oncology Data Advisor: Why is it important that the health care team participate in this activity?

Amy Goodrich, MSN, RN, CRNP: Due to our currently available and growing numbers of highly effective therapies in both the inpatient and the outpatient settings, it is important for all oncology clinicians to understand TLS risk assessment, prophylaxis, monitoring, and treatment strategies.Preventing and aggressively managing TLS is critical to optimizing patient outcomes.

Oncology Data Advisor: Can you briefly explain TLS prophylaxis and monitoring and why it is important for identifying TLS early?

Ms. Goodrich: Typically, allopurinol is used for TLS prophylaxis, starting two to three days prior to therapy initiation. Maximizing oral hydration is also an important element of TLS prophylaxis.For patients requiring urgent inpatient treatment, IV hydration and allopurinol, and possibly rasburicase, are common prevention strategies. It is important to monitor baseline chemistries and correct any abnormalities prior to initiating treatment. Post–therapy initiation, TLS lab monitoring is based on a patient’s risk. Close monitoring and prompt intervention if laboratory TLS is noted are undertaken to attempt to avoid progression to clinical TLS, which may include severe and/or fatal renal failure, cardiac arrhythmias, and neurological impairment.

Oncology Data Advisor: What are some things that are important for patients to know, and why is patient education vital to those at risk or already being treated?

Ms. Goodrich: It is important for patients to understand their risk of TLS and the plan to prevent TLS. Patient education should include the rationale for vigorous oral hydration and adherence to allopurinol dosing, as well as the plan for laboratory monitoring and potential management of any laboratory abnormalities after treatment. Patients and their support systems also require education on reportable signs and symptoms of TLS, to assure prompt assessment and intervention.

Oncology Data Advisor: Since recording this activity, have you learned anything new that you would like to add that you feel health care professionals should know?

Ms. Goodrich: The world of TLS has and continues to evolve slowly, despite being an oncologic emergency. TLS is not well quantified in the literature, and we are without universally accepted prevention, monitoring, and/or treatment strategies. Thank you for participating in this educational program and increasing your understanding of TLS to improve patient outcomes.

More about Ms. Goodrich

Amy Goodrich, MSN, RN, CRNP, is a Nurse Practitioner in the Hematologic Malignancies Program and Research Nursing Manager at the Johns Hopkins Kimmel Cancer Center. Ms. Goodrich handles treatment strategies for various types of hematologic malignancies, with a concentration on lymphomas.She is heavily involved in research operations at the Johns Hopkins Kimmel Cancer Center, and has provided many presentations on research topics including hematologic malignancies, new agents, and symptom management.

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 

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