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Colorectal Cancer: An Oncology Nursing Roundtable Discussion
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Colorectal Cancer: An Oncology Nursing Roundtable Discussion

This program was originally presented as an educational symposium during the ONS 8th Annual Institutes of Learning.

Friday, November 9, 2007
6:00 am – 7:45 am

Regency Ballroom A Hyatt Regency Chicago
Chicago, Illinois

Release Date: April 2008
Expiration Date: April 2009
Estimated Time to Complete Activity: 1 hour 44 minutes (Adobe Flash Player and Adobe Acrobat Reader required)

Posttest

I have read and understand the information presented on this page and agree to proceed with the educational activity.

Accreditation Information

Target Audience

This activity has been designed to meet the educational needs of patient care oncology nurses.

Purpose

To educate oncology nurses on the latest research advances in the treatment of colorectal cancer (CRC) and how to incorporate targeted agents into clinical practice.

Program Overview

In treating patients with advanced CRC, clinicians are looking toward an individualized continuum of care that merges the use of all active treatment regimens, applies knowledge gathered from ongoing clinical trials, and gives considerable weight to the patient’s unique circumstances. Current thought is that exposure to all agents with proven effectiveness in CRC—namely conventional cytotoxic agents such as oxaliplatin, capecitabine/5-FU, and irinotecan, as well as the targeted agents bevacizumab, cetuximab, and panitumumab—is more important than the sequence in which they are administered. In this program, a gastrointestinal oncologist will summarize the current treatment landscape to include the most recently reported research and address outstanding questions. An expert panel of gastrointestinal oncology nurses, with representation from diverse practice settings and clinical roles, will conduct a case-based panel discussion of strategies for managing therapy-related side effects that emerge throughout the CRC continuum of care. Major side effects to be discussed include rash, peripheral neuropathy, hypersensitivity reactions, palmar-plantar erythema, diarrhea, hypertension, and bleeding. Because management of many of these toxicities lacks consensus, members of the panel will describe their own practice experiences and they will elicit experiences of program attendees via audience response technology.

Learning Objectives

Upon completion of this program, participants should be better able to:
  • Recall recent clinical data regarding the role of XELOX vs. FOLFOX for metastatic CRC
  • Describe conclusions of recent clinical trial results regarding chemotherapy holidays for patients with metastatic disease
  • Explain recent perspectives on chemotherapy/biologic therapy combinations and sequencing in metastatic disease
  • Identify recent perspectives regarding the use of current chemotherapies for stage II and III disease
  • Distinguish and accurately assess common CRC treatment toxicities
  • Describe current approaches to the nursing management of common CRC toxicities

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the U.S. Food and Drug Administration. IMER, Bristol-Myers Squibb Company and ImClone Systems, Inc., Genentech BioOncology, and sanofi-aventis U.S. do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of IMER, Bristol-Myers Squibb Company or ImClone Systems, Inc., Genentech BioOncology, and sanofi-aventis U.S. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclosure of Conflicts of Interest

IMER requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by IMER for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Please refer to the individual Faculty Bio’s for statements.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Madelyn T. Herzfeld, RN, BSN, OCN®, reported no areas of conflict.

Dorothy Dulko, PhD, RN, AOCNP-C, reported no areas of conflict.

Davecia Ragoonath, MS, reported no areas of conflict.

 

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison to recommendations of other authorities.

 

Sponsored by:

IMER
  

 

 

 

 

Supported by independent educational grants from Bristol-Myers Squibb Company and ImClone Systems Incorporated, Genentech BioOncology, and sanofi-aventis U.S.
 

Faculty

Barbara Holmes Gobel, RN, MS, AOCN® (Chairperson)
Northwestern Memorial Hospital
  • Bio
  • Abstract

Ms. Holmes Gobel is an oncology clinical nurse specialist at Northwestern Memorial Hospital, Chicago, Illinois. She received her master’s degree from Rush University, Chicago, where she is currently an adjunct faculty member at the College of Nursing. The scope of her practice includes hematology/oncology and palliative care/hospice. She has authored several publications on cancer symptom management and lectures regularly on issues related to oncology nursing. Ms. Holmes Gobel is also director at large on the Oncology Nursing Society board of directors.

Barbara Holmes Gobel, RN, MS, AOCN®, reported a financial interest/relationship or affiliation in the form of: Speakers’ Bureau, Genentech BioOncology, & sanofi-aventis U.S.

Nursing Management of Colorectal Cancer Treatment Toxicities

Colorectal cancer represents the third leading cause of cancer and the second leading cause of all cancerrelated deaths in the United States. Colorectal cancer treatment has advanced tremendously during the past decade with the approval of irinotecan, capecitabine, oxaliplatin, bevacizumab, cetuximab, and panitumumab. This presentation uses illustrative case studies to outline preventive and management strategies for chemotherapy-induced peripheral neuropathy, hypersensitivity reactions, and bleeding events, all of which are among the most common side effects associated with colorectal cancer treatment.

Axel Grothey, MD
Mayo Clinic
  • Bio
  • Abstract

Dr. Grothey is a professor of oncology at the Mayo Clinic College of Medicine in Rochester, Minnesota. He has published and lectured extensively on a variety of oncology-related topics and served on the review or editorial boards of numerous oncology journals such as the British Journal of Cancer, Cancer Research, and Clinical Oncology. His research interests include the role of antiangiogenesis agents in the treatment of colorectal cancer, and he is currently the principal investigator for a clinical trial on this topic.

Axel Grothey, MD, reported a financial interest/relationship or affiliation in the form of: Consultant, sanofi-aventis U.S. Inc., Genentech BioOncology, Roche Laboratories, and Bristol-Myers Squibb Company.

Colorectal Cancer Treament

The treatment options currently available for the treatment of advanced colorectal cancer (CRC) appear to be an abundance of riches. The integration of oxaliplatin and irinotecan as conventional cytotoxic agents, as well as bevacizumab, cetuximab, and panitumumab as novel, targeted agents, have turned metastatic CRC into a disease with an expected overall survival now beyond 2 years for most patients. It cannot be overemphasized that this significant improvement in outcome is closely linked to the number of active drugs that exist.

The abundance of treatment options, however, comes with specific challenges for the practical management of palliative medical therapy. The most effective sequence of agents and combination regimens remains to be identified. Exposing patients to all active agents regardless of the sequence is conceivably more important for overall outcome than utilizing one specific sequence of treatment regimens. It is evident that the intensity of upfront therapy cannot–and should not–be maintained for the remainder of the patient's life without compromising his or her quality of life. Based on these considerations, an individualized therapeutic strategy has to be found with the goal to maximize treatment benefit (i.e., prolong overall survival and maintain the quality of life as long as possible).

Individualized treatment abandons the concept of specific lines of therapy in favor of providing all potentially effective treatment options to a patient, not unlike a continuum of care. This includes short chemotherapy-free intervals and reutilization of previously used agents in novel combinations. Beyond the palliative setting, an individualized, goal-oriented treatment approach is particularly important for patients who might have a chance of cure with resection of limited metastatic disease after neoadjuvant therapy.

In the adjuvant setting, FOLFOX has clearly emerged as the treatment of choice for stage III, and conceivably also for high-risk stage II disease, with improved 6-year overall survival for patients with lymph-node positive disease when compared with 5-FU/LV alone. Recent studies investigate the use of capecitabine as a substitute for infusional 5-FU, the integration of biologics such as bevacizumab and cetuximab, and the usefulness of genetic signatures to identify patients with stage II disease who might benefit most from adjuvant chemotherapy.

Fredrica A. Preston, RNC, NP, AOCN®
North Shore Cancer Center
  • Bio
  • Abstract

Ms. Preston is an oncology nurse practitioner at the North Shore Cancer Center in Peabody, Massachusetts. She has worked in oncology since 1975 and has served in a variety of roles in inpatient, outpatient, and hospice settings. She is a frequent speaker on several oncology nursing topics including supportive care for the elderly. Ms. Preston has authored many articles on cancer care and is the coeditor of Clinical Guidelines for Symptom Management in Oncology: A Handbook for Advanced Practice Nurses. She has been a member of the Oncology Nursing Society since 1977 and served as a core member of the Education and Nominating committees.

Fredrica A. Preston, RNC, NP, AOCN®, reported a financial interest/relationship or affiliation in the form of: Speaker’s Bureau, Amgen Inc., Bristol-Myers Squibb Company, and MGI PHARMA Inc.

Nursing Management of CRC Treatment Toxicities

Treatment for metastatic colorectal cancer has advanced considerably in recent years with the introduction of such agents as irinotecan, oxaliplatin, capecitabine, bevacizumab, cetuximab, and panitumumab. Successful patient outcomes depend not only on treatment response but also effective management of toxicities. It is the responsibility of oncology nurses to optimally manage side effects and intervene immediately when patients discuss with them the side effects they are experiencing. This presentation will review the management of three commonly encountered toxicities in the treatment of metastatic colorectal cancer: chemotherapy-induced diarrhea, palmar-plantar erythrodysesthesia, and rash.

 

 

Accreditation Statements

This educational activity for 1.7 contact hours will be provided by the Institute for Medical Education & Research (IMER). IMER is an approved provider of continuing education by the Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

A statement of credit will be issued only upon receipt of a completed activity evaluation form.

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