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FEATURE ARTICLE
Advanced Colorectal Cancer:
Current Treatment and Nursing Management
With Economic Considerations
Pamela Hallquist Viale, RN, MS, CS, ANP, AOCNP,
Anita Fung, PharmD, and Laura Zitella, NP, AOCN ®
C
olorectal cancer is
The introduction of irinoteColorectal cancer is one of the most common cancers
common in men and
can in 1996, followed by the
women. More than
first new platinum analog agent,
affecting men and women in the United States. In 2005,
56,000 people will die of the
oxaliplatin, in 2002, offered
10%
of
all
new
cancer
cases
in
men
will
be
colorectal;
disease in the United States
considerable advances in chefor women, 11% of new cases will be colorectal. The
in 2005 (Jemal et al., 2005).
motherapy for advanced and
Including Europe, the number
metastatic colorectal cancer
disease is the third most frequent cancer occurring in
rises to about 200,000 deaths
(Schrag, 2004). An oral fluoboth sexes. Colorectal cancer also is the third most
(Midgley & Kerr, 2000b). Early
rouracil agent, capecitabine,
frequent
cause
of
death
for
men
and
women,
and
more
diagnosis with better screening
was released in 1998 and has
than 56,000 cancer deaths in 2005 will be attributed to
has improved overall survival
been shown to have activity
for patients with colorectal canin colorectal cancer. Two new
colorectal cancer. Chemotherapy options for treatment
cer. Unfortunately, more than
monoclonal antibody agents, beof
the
disease
remained
relatively
stagnant
until
the
ap50% of new patients present
vacizumab and cetuximab, were
proval of irinotecan in 1996 followed by capecitabine,
with stage III or metastatic disapproved in 2004 for the treatease, and half of all people with
oxaliplatin, and the new targeted agents. The new agents
ment of patients with metastatic
colorectal cancer are diagnosed
colorectal cancer. The agents
have improved efficacy of treatment for colorectal cancer
with recurrent or metastatic disare different in tumor effects
and the lives of patients with advanced disease. With the
ease (Xiong & Ajani, 2004).
and side-effect profiles and may
new options for treatment come increased nursing and
Therefore, screening and early
diagnosis are crucial in helping
patient-teaching responsibilities, as well as increased
Submitted October 2004. Acto reduce mortality.
costs associated with the newer drugs in the armamencepted for publication April 6,
Because more patients with
2005. The primary author speaks
tarium of chemotherapy agents. Formulary budgets
colorectal cancer present with
for Abraxis Oncology; the Instilater-stage disease, effective
are seeing dramatic rises in expenditures for the new,
tute for Medical Education and
treatments are needed. Treattargeted therapy treatments; discussion of the most apResearch; Merck & Co., Inc.;
ments usually include systemic
Novartis; and Pfizer Inc. and
propriate
therapies
may
be
considered.
This
article
will
chemotherapy. Patients often reserves on the advisory boards
discuss epidemiology of colorectal cancer, treatment
ceive a combination of surgery,
for Amgen Inc., the Institute for
chemotherapy, and possibly radioptions in advanced colorectal cancer, and nursing care
Medical Education and Research,
ation therapy in the treatment of
crucial to patients undergoing chemotherapy. Discussion
Novartis, and Pfizer Inc. (Mention
stage III or advanced colorectal
of specific products and opinions
of economic impact also will be presented.
cancer. Although improvements
related to those products do not
have been made in surgical and
indicate or imply endorsement
radiation therapy techniques in the treatment & Kerr, 2000a; Rich, Shepard, & Mosely,
by the Clinical Journal of Oncology Nursing
of advanced colorectal cancer, 5-fluorouracil 2004). Chemotherapy options have changed
or the Oncology Nursing Society.)
(5-FU) has been the mainstay of chemother- dramatically since 2000 and will be the focus
apy for this patient population (Midgley
of this article.
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 9, NUMBER 5 • ADVANCED COLORECTAL CANCER
Digital Object Identifier: 10.1188/05.CJON.541-552
541