Integrative Tumor Board: Colon Cancer with Liver Metastases

Abstract

connected to their implanted ports. They spend the night at home, or, for patients who come to the center from outside of the Chicago area, in a nearby hotel. To use chronotherapy in an outpatient setting entails much behind-the-scenes planning and working out of details, but previous experience has shown that outpatient clinical use of this technology is quite feasible. 3Nurses function collaboratively with physicians in planning and implementing an individualized protocol for each patient. Patient and family teaching is complex, as both the patient and family need to be assured and feel comfortable about being treated with chemotherapy off-site as well as during sleep. Education needs to include basic trouble shooting for minor problems that may occur with the pump. Patients have access to nursing staff during the day and after clinic hours, through the night. Patients are provided with medications for nausea, vomiting, or diarrhea if needed and are educated thoroughly regarding these medications.Other responsibilities for our oncology nurses include research data collection, compliance with regulatory issues, quality assurance, inventory management, and continuing education on managing the technology and programming the pump. Other factors for the oncology nurse to oversee and be aware of are maintenance of the pumps, supplies, and staffing issues, as more nursing time per patient is needed initially when the patient is beginning a regimen of chronomodulated therapy. Documentation of the chemotherapy flow chart, patient assessments, and nursing care plan must be altered as well for this population of patients. Despite the increased work for nurses, a recent pharmacoeconomic analysis showed that the costs of chronotherapy and standard therapy for colon cancer using 5-FU, leucovorin, and oxaliplatin were equivalent: Although chronotherapy cost more to administer, there were fewer toxic reactions and longer time to progression. 4 Chronomodulated chemotherapy has been validated for the improvement of quality of life while undergoing treatment, including less nausea and vomiting, less diarrhea, less asthenia, and less interruption of daily activities. A growing amount of research demonstrates improved treatment outcomes as well. Family support for using chronotherapy is thus usually very strong, especially since the outpatient setting allows family members to feel more involved in the care of their loved one. Patient satisfaction is enhanced also by less need for hospital admissions and increased feeling of well-being. The initial transition to using outpatient chronotherapy did involve substantial alterations to our nursing procedures; once the new routines were incorporated, they proved to be manageable from the nursing and administrative perspectives. Home chronotherapy in our practice has proven to be a safe and acceptable alternative to traditional methods administering chemotherapy, and has provided many of our patients with a vastly improved quality of life as well as the potential for better outcomes. Refe...