APNs who care for patients with advanced CRC are faced with the challenge of developing individualized nursing management plans for patients with diverse disease presentations and a wide range of comorbidities that influence their ability to tolerate specific regimens. Selection of the most appropriate treatment regimen therefore must carefully balance the need to administer optimal dose intensity with the potential risks. APNs play an integral role in optimizing drug therapy, and therefore tools and strategies to facilitate the safe and efficacious use of all medications will further optimize patient outcomes.
Special populations need consideration in the care of CRC. The elderly are such a population. Traditionally the elderly have not been offered the same treatment regimens as younger patients because of what were considered intolerable side effects. However, recent clinical trials have shown that aggressive chemotherapy benefits elderly patients with metastatic CRC, with toxicities generally comparable to those observed in younger patients.
Another population that needs consideration is the population with unresectable liver metastases. APNs need to understand the options that are available and how their patients’ quality of life is affected by various treatment methods, whether the choice is local ablation to render the metastasis resectable, chemotherapy, or no treatment.
Another important consideration for APNs who work with CRC patients is survivorship. Recent years have seen an increase in treatment options. These treatments have helped to increase survivorship but also carry with them significant short-and long-term side effects. As patients are surviving longer, health care providers need to understand the impact of both the disease and the treatments on the quality of life of these patients and the issues that surround survivorship.
