Chapter 130: Colorectal Cancer

Patient Care Process for the Management of Colorectal Cancer

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

KEY CONCEPTS

• 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.

• Regular use of aspirin and other nonsteroidal anti-inflammatory drugs, calcium intake, ...