Interventional Oncology at Sylvester Comprehensive Cancer Center: Focusing on a Multidisciplinary Approach

A well-rounded and efficient staff is important to the success of any healthcare facility. At Sylvester ComprehensiveCancer Center in Miami, Florida, proficient and experienced staff members play an especially vital role in providing multidisciplinary care to patients.

Sylvester Comprehensive Cancer Center (SCCC), affiliated with The University of Miami Health System and Miller School of Medicine, instituted an Interventional Oncology (IO) practice in 2005. Currently, 28 staff members administer care at this 40-bed inpatient facility, including administrative director Evelyn P. Wempe, ARNP, OCN® and three attending physicians: Jose M. Yrizarry, MD, Govindarajan Narayanan, MD, and Ana M. Echenique, MD, with 25, 8, and 14 years of residency experience, respectively. According to Dr. Narayanan, physicians are board certified in radiology with a certificate of added qualifications in interventional radiology.

The center works to maintain an educated and experienced staff, explains Dr. Narayanan, Associate Professor of Clinical Radiology, Chief of the Section of Vascular/Interventional Radiology, and Director of the Vascular/Interventional Radiology Fellowship Program at the University of Miami Health System. He notes that nurses and technologists must complete initial competencies upon hire in addition to competency tests each year.

“All team members are part of weekly IO tumor boards and other educational conferences,” adds Dr. Narayanan. “The department also sponsors the team to attend the annual SYNERGY conference.”

A Multidisciplinary Approach

The center notes that this highly trained faculty is able perform a wide array of procedures, including the following:

• Transarterial chemoembolization (TACE) -- conventional and drug eluting beads (DEB)
• Selective internal radiation therapy (SIRT) with Y-90
• Radiofrequency ablation (RFA)
• Microwave ablation
• Cryoablation
• Irreversible electroporation (IRE)
• Combination treatments (ablation and transarterial)
• Biliary and renal drainages

 With plans to add an additional angiosuite, Dr. Narayanan and his colleagues currently utilize two angiography rooms, one computed tomography (CT) room, and one ultrasound room to perform interventional therapies in their facility. Here, he explains, they treat hepatocellular carcinoma (HCC), sarcoma, pancreatic and colon cancer, renal and neuroendocrine tumors, cholangiocarcinoma, bone and spine tumors, and diagnostic biopsies, and they perform spine procedures and venous access.

Dr. Narayanan says during procedures, each staff member is an important part in the care and management of IO patients.

“A registered nurse provides care and monitors the patient to ensure safety and comfort,” he notes. “The interventional radiology technologist assists the physicians in performing the case in terms of handling equipment, setting up the room, and handling images.”

Maintaining a Safe Environment

Radiation safety is just as important as staff competency in any oncology facility. According to Dr. Narayanan, although the physicians and technologists are solely responsible for operating equipment during the procedures, the entire staff maintains radiation precautions.

“Lead aprons are worn for all imaging-based cases. Dosimetry badges are also worn by the staff to monitor exposure to radiation on a monthly basis,” he continues. “Finally, the radiation safety officers conduct periodic checks to ensure the lead aprons are meeting standards and that the rooms are prepared for radiation use.”

Dr. Narayanan adds that documentation, infection control for central line-associated bloodstream infection, and hygienic practices are also in place for quality control and assurance.

Another aspect of safety involves proper security measures. Vendors who visit SCCC must register with the university through Reptrax and sign in with security upon arrival, according to Dr. Narayanan. Limited clearance for designated areas in the center maintains added security.

“Vendors are not allowed in procedure areas unless their input is needed, for example, for input on a new technology,” adds Dr. Narayanan.

Recently, the center has implemented the Siemens CT scanner Somatom Definition AS and Siemens Artis Z Angiosuite.

Patient Comfort and Care

Proper patient care and preparation are also a part of SCCC’s safety procedures. Various members of the staff work to ensure that they perform the appropriate IO procedures efficiently. Various specialties throughout the facility (oncology, surgery, nephrology, and others) refer patients to the IO center, explains Dr. Narayanan.

“Referral cases are reviewed by the interventional radiology attending physician to determine if clinical presentation warrants an IO procedure and if so, which would be the best option,” he adds.

Once the physician recommends the patient for an IO procedure, Dr. Narayanan explains that a registered nurse from the department will collect clinical information, medical history, medications, and allergies to ensure the best care and patient safety.

The IO team also includes advance practice providers (nurse practitioners and physician assistants) to review clinical information, ensure that patients are clinically optimized for their IO procedure, and provide patient education and reassurance.

Final Thoughts

Safety, excellent patient care, organization, and competence contribute to an excellent healthcare facility. At SCCC, Dr. Narayanan and his colleagues work to provide that level of care and expertise in a well maintained environment. A multidisciplinary center requires tireless effort and high-quality care. With a skilled and knowledgeable staff, sound procedures and a structured atmosphere, a superior multidisciplinary cancer center is achieved.