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Program Abstracts
There Is No Place Like Hope: Chronicles of Colon Cancer Survivors
Optimizing Care of Colon Cancer Patients
Many advances have been made in both the adjuvant treatment of
colorectal cancer and the treatment of metastatic colorectal cancer. While
these advances have enhanced the care of patients, it has also made care
increasingly complex. The potential side effects of therapy have expanded
and now include: myelosuppression, mucositis, nausea, vomiting, diarrhea,
hypersensitivity, hypertension, proteinuria, cutaneous toxicities, and
neurotoxicities.
In addition to educating patients and their families about these toxicities,
oncology nurses utilize assessment skills to detect toxicities and intervene
to prevent and treat them. This presentation will review the nursing
implications of these potential toxicities and provide a forum for an
exchange of ideas regarding them.
Treatment of Metastatic Colorectal Cancer
Over the past decade, much progress has been made in the treatment of and
survival outcomes for patients with advanced colorectal cancer. With combined
modality treatments, patients can achieve median survival of more than 24
months. Though fluorouracil remains the mainstay of most regimens, the
integration of new chemotherapies, such as oxaliplatin and irinotecan, and
targeted therapies, such as the VEGF inhibitor bevacizumab and the EGFR
inhibitor cetuximab, has greatly enhanced our ability to provide meaningful clinical
results. Newly adopted regimens will be discussed, including the pivotal trials that
led to their approval. With the development of these new treatment modalities,
new toxicities have been identified and need to be recognized by the medical
caregivers who will provide appropriate interventions on a timely basis.
Researchers continue to explore innovative therapies with the hopes of identifying
paradigms that will lead to further increases in overall survival.
Advances in Adjuvant Therapy for Colon Cancer
There have been significant advances in adjuvant therapy in colon cancer in recent
years. Adjuvant therapy refers to therapy given in addition to primary treatment,
such as surgery. When given prior to surgery it is known as neoadjuvant therapy.
The aim of adjuvant therapy is to increase chances of long-term cure by eradicating
micrometastatic disease. For colon cancer, adjuvant therapy is typically given
within 4 to 6 weeks after surgery and administered over a 6-month period.
The concept of adjuvant therapy is often difficult to explain to a patient since not all
patients will actually benefit from this treatment. Furthermore there is no way to
determine in advance which patients will benefit. For this reason adjuvant therapy
is considered for all appropriate patients.
Adjuvant therapy has been shown to have a major impact for patients with stage III
disease. Its effect on patients with stage II disease is not quite as clear, but may be
beneficial for a select group, especially those who appear to be at high risk for
recurrence.
Standard adjuvant therapy consists of 5-fluorouracil given with a B-vitamin, leucovorin.
Emerging data suggest overall superiority of regimens such as FOLFOX (5-
fluorouracil, leucovorin, and oxaliplatin) for most patients. Capecitabine as a single
agent has also been approved for adjuvant therapy. Other therapies that combine
5-FU and irinotecan have not been found to be useful in the adjuvant setting.
Biologic agents such as bevacizumab and cetuximab have been shown to add to
the efficacy of chemotherapeutic agents in the metastatic setting. The role these
new biologic agents will have in the adjuvant treatment of colon cancer remains to
be determined. Several studies are actively recruiting patients to determine where
biologic agents will fit.
Finally, genomic markers in colon cancer may also prove helpful in predicting
which patients are most likely to benefit from adjuvant therapy.
