Ascites

Karen, thank you so much for all of that terrific information. I really appreciate it!

Very best,
Steven

Steven,

I will say that in my practice of close to 20 years, I recall giving albumin infusions two times for acites related issues/cancer affecting the liver. One of these times was at an academic medical facility, and once at a community cancer center. I do remember that the individuals whom I gave the infusions were stable, though very ill.

There is quite a balancing act that occurs to keep an individual safe, and all treatments must be carefully considered and the risks vs. benefits.

Albumin is a blood product and is infused and treated similarly to a blood transfusion, though it has a lower risk of reaction. It is generally given as a volume expander and must be used with caution.

http://www.fda.gov/downloads/Biolog…ionatedPlasmaProducts/ucm056844.pdf

Your post had me searching through medical literature to see what the experts have to say about albumin infusion for the treatment of ascites/edema, and here is what I found:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290049/

“Management of patients with ascities in GI malignancies is controversial”.

“A logical approach is to individualize treatment. The rationale in the management of malignant ascites involves consideration of survival and QoL issues. Palliative techniques play an important role in the reduction of symptoms, which bear a direct correlation to patient satisfaction and therapeutic choices”.

QoL= Quality of life

“The most commonly used means of managing malignant ascites was paracentesis, which was also felt to be the most effective by the group surveyed. After paracentesis, diuretics and peritoneovenous shunting were used most frequently, but there was no apparent consensus as to their effectiveness.14 A survey by Lee and colleagues showed that paracentesis and diuretics were the most commonly used procedures in management of malignant ascites followed by peritoneovenous shunts, diet measures and other modalities like systemic or intraperitoneal chemotherapy”.

“There is no evidence of concurrent albumin infusions in patients with malignant ascites”.

It is difficult to find literature on the use of albumin for malignant ascites. Most of what I have found discusses the treatment of ascites in patients with cirrhosis.

The indications for albumin infusion for someone such as your mother may be if she has at least 5 liters of fluid removed via her abdominal catheter (White, 2014). This appears to be a common reason for the use of albumin, and similar to your mother’s situation. This same article by White does state albumin has been used to “mobilize ascites” although the studies cited discussed individuals with cirrhosis of the liver.
Outpatient Interventions for Hepatology Patients With Fluid Retention: A Review and Synthesis of the Literature
White, Asha DNP, RN, ACNS-BC

There are other studies that I have read that state that the use of albumin is well established in certain instances (large volume paracentesis, volume expansion, kidney disease, etc.), but controversial in others (high blood pressure (hypertension), fluid in the lungs (pulmonary edema), anemia, etc).

So, I know that I have thrown a lot of information at you, but it is good to see what the evidence out there says about treatment for ascites. I can say without hesitation that in my experience, treatment of ascites/edema is based on the quality of life of the affected individual. I have seen people have a weekly paracentesis performed, or a valved catheter with which to periodically drain the fluid. I’ve also seen medications like Lasix given to reduce the fluid retention, as well as restricting sodium and fluid intake. Other times no measures are taken as the individual is comfortable and treatment will do more harm than good.

I feel that if I were in your situation, there would be no harm in asking your mother’s oncologist how they feel about albumin infusion for the treatment of her ascites/edema. Perhaps you will find that they may be open to trying it, especially since she is being treated at Rutgers. Although one study I read did not recommend it for use in malignant ascites, this study is from 2009 and new evidence may be available that contradicts the findings of this study.

Most importantly and the reason for putting so much information into this post, is that being informed and able to discuss treatment with the oncologists/nurses will help you as you advocate for your mother. You never know, perhaps you will spark an idea in the oncologist and help them to consider treatments that they might not have otherwise!

All the best to you and your mother, Steven!

Karen D., BSN, RN, CHPN

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Karen and CC FIghting Family, my mother has been experiencing similar fluid development and retention issues and has a catheter in her belly that we use to drain about a liter per day. I understand the causation is likely due to protein deficiency caused by liver function issues related to cancer progression. Mom is also on TPN due to issues with eating and appetite. Is there any treatment or medication to increase or supplement Albumin levels?

Right now, mom has had one infusion of Keytruda two weeks ago and we are exploring with her oncologist the use of Dasatinib/Sprycel given that she has the IDH mutation in her cancer.

Thank you,
Steven