Nurse-Led Study Evaluates Safe Use of Nephrostomy Tube to Deliver Chemotherapy and Biotherapy

Upper urinary tract urothelial carcinoma in situ or small tumors in the kidney area

Researchers at the Rutgers Cancer Institute of New Jersey are testing the possibility of sending treatment drugs directly to the kidney in patients with upper urinary tract urothelial carcinoma in situ or small tumors in the kidney area. They shared the results at the ONS Annual Congress in San Antonio, Texas.

“The goal of this procedure is to preserve the kidney, so the kidney doesn’t have to be removed,” Ellen Sterman, RN, APN-C, AOCNS, of the Rutgers Cancer Institute of New Jersey, said in an interview with Oncology Nursing News.

So far, two of the three patients involved in the study at Rutgers showed no signs of cancer recurrence at their medical recheck, and the third patient did show the return of cancer, causing him to get his kidney removed. But the researchers remain optimistic about the procedure and plan to continue going forward with evaluating it.

“We need to have a few more patients. Right now we’ve done this with three patients,” Kathy Morris, BSN, RN, OCN, RNC, also of the Rutgers Cancer Institute said. “We need to get a few more, so we can elaborate on it and follow them and see how well they do.”

The procedure, which Sterman said is being evaluated in a handful of centers across the United States, as well as in Europe, works by temporarily inserting a nephrostomy tube into the patient after surgery, and then the patient receives either chemotherapy or the biotherapy, such as Bacillus Calmette—Guérin, directly to the kidney to kill off cancer cells. Typically, nephrostomy tubes are used for kidney blockage to drain urine, but here, patients don’t necessarily have to have blocked kidneys. After the chemo or immunotherapy is pumped through the tube and into the kidney, it is eventually urinated out, so the process encompasses the whole urinary tract.

While safe for patients, Sterman emphasized that there are some safety measures by which oncology nurses and doctors administering the tube should be aware of.

“The safety issues primarily affect the oncology nurse, so we want to make sure they’re using all the protective oncology equipment. They need to protect themselves, and that includes a chemo gown, two pair of gloves, and a mask with an eye shield,” Sterman said.

Those safety tips are important, especially now that nurses are able to administer the procedure, explained Morris. “We made a policy because prior to that, only the physician could administer it because we didn’t have a policy that covered the nurses,” she said, adding how the study is moving forward:

“We have already implemented the nursing education. We have a competency, and we have a patient education sheet, so patients know what kind of care they’re getting and the safety following their care and discharge from the center.”

Sterman emphasized the importance of nurses in cancer care, not only with nephrostomy- delivered chemotherapy and immunotherapy, but in all aspects.

“Nurses need to just make sure that there’s enough time not only to safely care for the patient and provide the education, but it’s also important to offer emotional support during and after their treatments,” Sterman said.