Putting Evidence Into Practice

Abstract

This article will provide an overview of the principal toxicities associated with commonly used chemotherapy treatment regimens for metastatic colorectal cancer (mCRC) and explore the role of the oncology nurse in the management of treatment-associated toxicity. Although patients with mCRC have benefited considerably from recent therapeutic advances, the use of more complex treatment regimens has inevitably resulted in an increase in treatment-related toxicities. This can ultimately lead to dose reductions, delays, or discontinuation of therapy, which may negatively affect efficacy outcomes. Early identification and treatment of toxicities often can allow treatment to continue as planned or at a lower dose, if required. The oncology nurse is ideally positioned to assist with the timely recognition and management of side effects. This allows therapy to be continued on schedule and at the appropriate dose, enabling patients to achieve a better clinical outcome and maintain or improve their quality of life.

Torsade de Pointes, Prolonged QT Intervals, and Patients With Cancer

“…Diarrhea, a common issue in patients with cancer, can cause hypokalemia. Cancer, surgery to the bowel, radiation involving the gastrointestinal tract, antibiotics, epithelial growth factor inhibitors, and certain chemotherapeutic agents (e.g., 5-fluorouracil, capecitabine, cytarabine) all can cause diarrhea and, therefore, hypokalemia (Muehlbauer et al, 2009;Polovich, Whitford, & Olsen, 2011). Examples of chemotherapeutic agents that can cause hypomagnesemia include cisplatin and carboplatin (Polovich et al, 2011).…”

Adherence, Dosing, and Managing Toxicities With Trifluridine/Tipiracil (TAS-102)

“…39 The initial management of Grade 1/2 diarrhea should include modifications to the patient’s diet (small, frequent meals and elimination of lactose, alcohol, and high-osmolar supplements) and consultation with a registered dietician (Figure 2B). 39,40 In general, for patients with Grade 1/2 diarrhea, treatment with the oral opiate loperamide hydrochloride is sufficient (4 mg initial dose followed by 2 mg every 4 hours, to a maximum of 16 mg/day) with or without diphenoxylate/atropine (1–2 tablets of 2.5/0.025 mg PO 24 times/d, to a maximum of 8 tablets/day). 39 For patients with persistent, Grade 3/4 diarrhea and severe dehydration, it may be necessary to administer octreotide acetate, a somatostatin analog (subcutaneously 100 to 150 μg TID or IV 25–50 μg/h) for the management of severe diarrhea and to achieve rapid control.…”

Identifying Strategies to Optimize Care With Oral Cancer Therapy

“…Chemotherapy has been associated with diarrhea rates ranging from 50%-80% (Muehlbauer et al, 2009). The majority of research pertaining to diarrhea in the oncology patient population has focused on IV chemotherapy.…”

“…Based on information fromAppleby et al, 2011;Baas et al, 2012;Balagula, Garbe, et al, 2011;Burtness et al, 2009;Degen et al, 2010;Eaby et al, 2008;Eisen et al, 2012;Esper, 2012;Fischer et al, 2013;Gibson et al, 2013;Hudes et al, 2011;Minton et al, 2011;Muehlbauer et al, 2009;Stein et al, 2010;Sun, 2012;Wu et al, 2011. Based on information fromAppleby et al, 2011;Baas et al, 2012;Balagula, Garbe, et al, 2011;Burtness et al, 2009;Degen et al, 2010;Eaby et al, 2008;Eisen et al, 2012;Esper, 2012;Fischer et al, 2013;Gibson et al, 2013;Hudes et al, 2011;Minton et al, 2011;Muehlbauer et al, 2009;Stein et al, 2010;Sun, 2012;Wu et al, 2011. …”