LEARNING OBJECTIVESAfter completing this course, the reader should be able to:1. Discuss recent progress in the treatment of patients with advanced colorectal cancer.2. Define the continuum-of-care approach and how it may differ from our current approach to the treatment of patients with advanced colorectal cancer.3. Identify key factors in treatment selection for patients with advanced colorectal cancer.4. Explain the impact of each active drug in the treatment of advanced colorectal cancer and the impact of treatment with multiple agents over the course of the disease.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTNew agents for the treatment of metastatic colorectal cancer have extended median overall survival to more than 20 months, an increase that has changed the view of advanced colorectal cancer from an acute to a chronic

Only nurses knowledgeable about extravasation and skilled in associated techniques should assume responsibility for vesicant administration.

Mary Lappe, RN, BSN, OCN® [Oncology nurse clinician]Oncology Specialists, S.C AbstractPurpose/Objectives-To describe factors related to taste changes, to examine patients' use of a self-care suggestion sheet to manage taste changes associated with chemotherapy, and to identify potentially useful strategies for managing specific taste changes after chemotherapy.Design-Quasi-experimental, pre/post design. Setting-Four outpatient urban and suburban oncology centers in Illinois.Sample-42 patients who had received at least two cycles of chemotherapy previously identified to be associated with taste changes.Methods-Pre-and postintervention survey of taste changes; patient education regarding self-care for taste changes.Main Research Variables-Taste changes, taste change strategies, and self-care.Findings-Most patients that reported taste changes had affected their ability to eat. Taste changes and strategies varied somewhat according to chemotherapy regimen. Avoiding strong-smelling ortasting foods, eating blander foods, drinking more water with foods, oral care before eating, and eating smaller, more frequent meals were reported to help.Conclusions-Taste changes are common in patients receiving cisplatin, carboplatin, or cyclophosphamide. At-risk patients may benefit from prechemotherapy teaching regarding specific taste change management suggestions. Use of a taste change suggestion sheet encouraged self-care, No financial relationships to disclose. NIH Public Access Author ManuscriptOncol Nurs Forum. Author manuscript; available in PMC 2010 June 29. Published in final edited form as:Oncol Nurs Forum. 2009 March ; 36(2): E47-E56. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript and counseling patients regarding strategies to deal with taste changes may help them during chemotherapy.Implications for Nursing-Nurses should incorporate patient education tools that promote selfcare regarding the management of taste changes in patients with known factors that could affect taste early in their chemotherapy.Chemotherapy agents can cause a wide range of adverse effects. One such cluster of manifestations that has gained greater attention in the literature is taste changes, which typically are described by severity, distress, and effects on usual activities. For instance, 38%-77% of patients with cancer have reported significant taste changes after receiving chemotherapy

Advances in supportive care have increased the likelihood that previously less common adverse effects of chemotherapy will be more evident. The incidence of chemotherapy-induced peripheral neuropathy (CIPN) is increasing because more neurotoxic drugs have been developed and because patients are living longer and receiving multiple chemotherapy regimens. This article reviews the anatomy of the peripheral nervous system, the proposed mechanisms of CIPN, and manifestations of CIPN from vinca alkaloids, taxanes, and platinum analogs. Major topics of this article are evidence-based data regarding symptom management, a review of medical management, and a synthesis of nursing care for patients at risk for or experiencing CIPN.

Background NEPA, a combination antiemetic of a neurokinin‐1 (NK1) receptor antagonist (RA) (netupitant [oral]/fosnetupitant [intravenous; IV]) and 5‐HT3RA, palonosetron] offers 5‐day CINV prevention with a single dose. Fosnetupitant solution contains no allergenic excipients, surfactant, emulsifier, or solubility enhancer. A phase III study of patients receiving cisplatin found no infusion‐site or anaphylactic reactions related to IV NEPA. However, hypersensitivity reactions and anaphylaxis have been reported with other IV NK1RAs, particularly fosaprepitant in patients receiving anthracycline‐cyclophosphamide (AC)‐based chemotherapy. This study evaluated the safety and efficacy of IV NEPA in the AC setting. Materials and Methods This phase IIIb, multinational, randomized, double‐blind study enrolled females with breast cancer naive to highly or moderately emetogenic chemotherapy. Patients were randomized to receive a single 30‐minute infusion of IV NEPA or single oral NEPA capsule on day 1 prior to AC, in repeated (up to 4) cycles. Oral dexamethasone was given to all patients on day 1 only. Results A total of 402 patients were included. The adverse event (AE) profiles were similar for IV and oral NEPA and consistent with those expected. Most AEs were mild or moderate with a similarly low incidence of treatment‐related AEs in both groups. There were no treatment‐related injection‐site AEs and no reports of hypersensitivity or anaphylaxis. The efficacy of IV and oral NEPA were similar, with high complete response (no emesis/no rescue) rates observed in cycle 1 (overall [0–120 hours] 73.0% IV NEPA, 77.3% oral NEPA) and maintained over subsequent cycles. Conclusion IV NEPA was highly effective and safe with no associated hypersensitivity and injection‐site reactions in patients receiving AC. Implications for Practice As a combination of a neurokinin‐1 (NK1) receptor antagonist (RA) and 5‐HT3RA, NEPA offers 5‐day chemotherapy‐induced nausea and vomiting prevention with a single dose and an opportunity to improve adherence to antiemetic guidelines. In this randomized multinational phase IIIb study, intravenous (IV) NEPA (fosnetupitant/palonosetron) was safe and highly effective in patients receiving multiple cycles of anthracycline‐cyclophosphamide (AC)‐based chemotherapy. Unlike other IV NK1RAs, the IV NEPA combination solution does not require any surfactant, emulsifier, or solubility enhancer and contains no allergenic excipients. Hypersensitivity reactions and anaphylaxis have been reported with other IV NK1RAs, most commonly with fosaprepitant in the AC setting. Importantly, there were no injection‐site or hypersensitivity reactions associated with IV NEPA.

Nurses who administer vesicant agents should understand the nursing and collaborative actions that should be taken to minimize patient morbidity, pain, and disability.

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tudies of how patients respond to treatment over time are fundamentally important to understanding how therapies influence quality of life and progression of disease during survivorship. When investigators examine change over time in continuous variables (e.g., patient self-reports of pain, fatigue, or nausea) in the same individuals, repeated measures are typically analyzed using analysis of variance (ANOVA) or perhaps latent growth curve modeling (Brant et al., 2011;Dudley, McGuire, Peterson, & Wong, 2009). Other studies-particularly those that compare the longterm effects of new drugs or other therapeutic regimens to some "standard" therapy-focus on time to binary (yes/no) disease-related events of interest, such as death (time to event). Such studies are particularly apropos to generating improvements in cancer therapies, in which new treatments are compared to "standard" regimens, and are shown or disproved to extend progression-free survival (PFS), time to progression, or overall survival (OS) in patients with a particular cancer. Time-to-event studies typically employ two closely related statistical approaches, Kaplan-Meier (K-M) analysis and Cox proportional haz-