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PATIENT CARE PROCESS

Patient Care Process for the Management of Colorectal Cancer

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Collect

  • Patient characteristics (e.g., age, race, sex)

  • Patient history (lifestyle factors – alcohol use, tobacco use, physical activity)

  • Patient characteristics (e.g., social history/situation, insurance coverage) and treatment preferences

  • Patient medical and family history (e.g, performance status, concurrent disease states [inflammatory bowel disease, colorectal cancer, polyps])

  • Clinical presentation signs and symptoms (see Clinical Presentation Box)

  • Current signs and symptoms and evaluation of tumor growth (for follow-up visits)

  • Current medications (prescription, over-the-counter, and complementary or alternative)

  • Objective data

    • BP, heart rate (HR), height, weight, and BSA

    • Labs (e.g. serum electrolytes, renal function, liver chemistries, complete blood count, coagulation studies, carcinoembryonic antigen [CEA] level – see Workup)

    • Physical examination data (e.g., hepatomegaly, lymphadenopathy, ascites)

    • Colorectal cancer staging (see Table 130-6)

    • Colorectal tumor genomics (e.g., KRAS, NRAS, MSI, BRAF, PIK3CA; see Table 130-11)

Assess

  • Risk factors for treatment-related toxicities (e.g., UGT1A1*28 genotype, poor nutritional intake, uncontrolled blood pressure or hypertension, baseline peripheral neuropathy)

  • Type of and response to prior treatments

  • Potential for disease responsiveness to specific agents and risk factors for disease recurrence

  • Potential problems with medication adherence to oral treatment regimens

  • Need for drug dose reductions or supportive care

Plan*

  • Goals of treatment (initial or continued)

  • Drug therapy regimen including specific anticancer agent(s), dose, route, frequency, and duration (see Tables 130-7, 130-8, 130-10)

  • Supportive care plan (e.g., antiemetics, prophylactic antidiarrheals, infusion reaction prophylaxis)

  • Monitoring parameters including efficacy (e.g., cancer imaging studies-chest, abdominal, and/or pelvic CT scans and radiographs, CEA if previously elevated, symptoms of recurrence), safety (medication-specific adverse effects, including major-dose limiting toxicities), and timeframe (see Table 130-8)

  • Patient education (e.g., goals of treatment, expected and potential serious toxicities, drug therapy, and monitoring and management plan)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Survivorship care plan (e.g., primary prevention of other diseases, such as infections, and other cancers, support systems for maintaining healthy lifestyle choices and BMI)

Follow-up: Monitor and Evaluate

  • Determine disease response to treatment (see Evaluation of Therapeutic Outcomes) and occurrence of disease progression or recurrence (cancer imaging studies-chest, abdominal, and/or pelvic CT scans and radiographs, CEA if previously elevated)

  • Presence of adverse effects (see Evaluation of Therapeutic Outcomes section and Table 130-8)

  • Patient adherence to treatment plan using multiple sources of information (e.g., patient self-report, medication administration records or refill data)

  • Patient's satisfaction with treatment, including understanding of adherence

*Collaborate with patient, caregivers, and other health professionals

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

For the chapter in the Wells Handbook, please go to Chapter 61. Colorectal Cancer.

KEY CONCEPTS

KEY CONCEPTS

  • Image not available. Advancing age, inherited and acquired genetic susceptibilities, lifestyle factors, inflammatory bowel disease, type 2 diabetes mellitus, and environmental factors are associated with colorectal cancer risk.

  • Image not available. Regular use of aspirin and other nonsteroidal anti-inflammatory drugs, calcium intake, and higher blood ...

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