OncologyConsults



The Role of the Oncology Nurse in Effective AE and Toxicity Management in Patients with
Metastatic and Refractory Colorectal Cancer

Presented by the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing.

Supported by an educational grant from Amgen Inc and Taiho Oncology, Inc.

OVERVIEW
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States, expected to cause approximately 50 630 deaths in 2018. Standard-of-care chemotherapy with 5-fluorouracil (5-FU)–based regimens (eg, 5-FU/leucovorin with oxaliplatin [FOLFOX], 5-FU/leucovorin and irinotecan [FOLFIRI], etc) have been the gold standard for patients with metastatic CRC (mCRC). Recently, the addition of targeted monoclonal antibodies, including bevacizumab, cetuximab, and panitumumab (for KRAS/NRAS wild-type patients), has resulted in improved response rates and overall survival (OS). However, the 5-year survival rate for patients with metastatic disease remains low (12%). Management of specific toxicities related to the various therapies used to treat patients with mCRC is the key to maintaining quality-of-life. It also aids in the tolerability of treatment, which enables patients’ to expand their time on therapy and increase their OS rate. Nurses are at the front line and are often able to identify toxicity early. As crucial members of the patient’s multidisciplinary team, nurses plays an important role in the identification of treatment-related toxicity and in initial management. This interactive educational activity will review common therapy options, discuss toxicity recognition/grading, and treatment options for patients with mCRC.

GOAL
The goal of this activity is to provide oncology nurses and other healthcare providers (HCPs) key strategies to manage toxicities associated with therapies utilized in the treatment of metastatic and refractory CRC patients.

TARGET AUDIENCE
This activity is intended for oncology nurses, oncology advanced practice nurses, oncology HCPs (oncologists, oncology physician assistants, surgical oncologists, and fellows) and all other HCPs who care for mCRC patients. No prerequisites required.

LEARNING OBJECTIVES
After participating in this activity, the participant will demonstrate the ability to:
  • DESCRIBE and SUMMARIZE the efficacy and safety of new and emerging treatments for metastatic and refractory CRC.
  • EMPLOY strategies to balance the efficacy and toxicity of treatments for metastatic and refractory CRC patients based on the tumor and patient characteristics.
  • RECOGNIZE toxicities associated with treatments and DEVELOP individual plans to manage complications in metastatic and refractory CRC patients.
  • IDENTIFY and DISTINGUISH resources and guidelines designed to manage treatment-related toxicities in mCRC treatment strategies and provide patient education.
The Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing take responsibility for the content, quality, and scientific integrity of this CME/CNE activity.

CE INFORMATION
Accreditation Statements
accme_logoThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Credit Designation Statements — The Johns Hopkins University School of Medicine designates this enduring material internet activity for a maximum of 0.5 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This .5 contact hour educational activity is provided by the Institute for Johns Hopkins Nursing. Claim only those contact hours actually spent in the activity. Statements will be awarded for this educational activity until October 28, 2019.

The estimated time to complete this activity: 30 minutes.

Release date: October 29, 2018     Expiration date: October 29, 2019

Policy On Speaker and Provider Disclosure
It is the policy of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing that the speaker and provider globally disclose conflicts of interest. The Johns Hopkins University School of Medicine OCME has established policies that will identify and resolve conflicts of interest prior to this educational activity. Detailed disclosure will be made prior to presentation of the education.

Full Disclosure Policy Affecting CME Activities
As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) requires attested and signed global disclosure of the existence of all financial interests or relationships with commercial interest from any individual in a position to control the content of a CME activity sponsored by OCME. The following relationships have been reported for this activity:

Planner Disclosures
Dr. Ettinger reports serving as a principal investigator for Golden Biotechnology Corp and serving as a consultant for AbbVie Inc, BeyondSpring Pharmaceuticals, Inc, Boehringer Ingelheim Vetmedica, Inc, Bristol-Myers Squibb Company/Sanofi-Aventis US LLC, Eli Lilly and Company, Guardant Health Inc., and Genentech Inc.

No other individual with the opportunity to affect this educational content has indicated any financial interests or relationships with a commercial entity

Note: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

FACULTY
Johns Hopkins University School of Medicine Chair and Planner
David S. Ettinger, MD

Alex Grass Professor of Oncology
Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland

Participating Faculty
Cara Wilt, RN, MSN, CRNP

Medical Oncology, GI Malignancies
Sidney Kimmel Comprehensive Cancer Center
The Johns Hopkins Hospital
Baltimore, Maryland

Nurse Planner
Rebecca Barshick, RN, MSN

Nurse Educator
The Institute for Johns Hopkins Nursing
Baltimore, Maryland

Nurse Reviewer
MiKaela Olsen APRN-CNS, MS, AOCNS, FAAN

Oncology and Hematology Clinical Nurse Specialist
Ambulatory Oncology
Sidney Kimmel Comprehensive Cancer Center
Johns Hopkins University School of Medicine
Baltimore, Maryland

Peer Reviewer
Susan L. Gearhart, MD

Associate Professor of Surgery
Director of Pharmacy
Johns Hopkins University School of Medicine
Baltimore, Maryland

Off-Label Product Discussion
No author has indicated that he/she will reference unlabeled/unapproved uses of drugs or products.

Non-Endorsement of Products
The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.

DISCLAIMER
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own. This activity is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format, design, and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

CONFIDENTIALITY DISCLAIMER FOR CME ACTIVITY PARTICIPANT
I certify that I am participating in this Johns Hopkins University School of Medicine activity for CME-accredited training and/or educational purposes.

I understand that while I am participating in this capacity, I may be exposed to "protected health information," as that term is defined and used in Hopkins policies and in the federal HIPAA privacy regulations (the “Privacy Regulations”). Protected health information is information about a person's health or treatment that identifies the person.

I pledge and agree to use and disclose any of this protected health information only for the training and/or educational purposes of my visit and to keep the information confidential. I agree not to post or discuss this protected health information, including pictures and/or videos, on any social media site (eg, Facebook, Twitter, etc.), in any electronic messaging program or through any portable electronic device.

I understand that I may direct to the Johns Hopkins Privacy Officer any questions I have about my obligations under this Confidentiality Pledge or under any of the Hopkins policies and procedures and applicable laws and regulations related to confidentiality. The contact information is: Johns Hopkins Privacy Officer, telephone: 410-735-6509, e-mail: HIPAA@jhmi.edu.

“The Office of Continuing Medical Education at the Johns Hopkins University School of Medicine, as sponsor of this activity, has relayed information with the CME attendees/participants and certify that the visitor is here for training, education and/or observation purposes only.”

For CME questions, please contact the CME Office at 410-955-2959 or e-mail cmenet@jhmi.edu.
Johns Hopkins University School of Medicine
Office of Continuing Medical Education
720 Rutland Avenue/ Turner 20
Baltimore, Maryland 21205-2195
Reviewed & Approved by: General Counsel, Johns Hopkins Medicine (4/1/03) (Updated 4/09 and 3/14)

HARDWARE & SOFTWARE REQUIREMENTS
Pentium 800 processor or greater, Windows 98/NT/200/XP or Mac OS 9/X or later, Microsoft Internet Explorer, Safari, Firefox, Windows Media Player 9.0 or later Flash player, 128 MB of RAM Monitor settings: High color at 800 x 600 pixels, Sound card and speakers, Adobe Acrobat Reader.

THE INSTITUTE FOR JOHNS HOPKINS NURSING MISSION STATEMENT
The mission of the Institute for Johns Hopkins Nursing is to share the innovations of Johns Hopkins Nursing in practice, education, and research—locally, nationally, and globally. Our goal in continuing nursing education is to bring you activities that reflect the expertise and creativity of Johns Hopkins Nursing. Our service values are quality, integrity, flexibility, and personal attentiveness. We appreciate your thoughts and welcome your concerns—please feel free to e-mail us: IJHN@.jhmi.edu.

ACTIVITY INSTRUCTIONS
The following is an interactive case module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, an interactive case study, and a CME/CNE post-test and evaluation. All 3 sections must be completed to receive CME/CNE credit. A certificate of participation will be available online immediately following successful completion of the activity.

Preassessment

The Role of the Oncology Nurse in Effective AE and Toxicity Management in Patients with Metastatic and Refractory Colorectal Cancer
Cara Wilt, RN, MSN, CRNP

Postassessment and Evaluation

This activity was developed in collaboration with ASiM.


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