Pamela Hallquist Viale, RN, MS, CS

One of the potential side effects of chemotherapy is cardiac toxicity. The resulting damage to the heart can range from non–life-threatening events to devastating heart failure. The spectrum of these events can occur almost immediately, during a drug infusion, or as a delayed complication later in the patient’s life. Oncology nurses not only need to be familiar with identifying and intervening in acute cardiac events, but also in some instances will need to monitor for delayed cardiac toxicities during the continuum of the patient’s life.

In recent years, both the cost and efficiency of medical care have emerged as important considerations and areas of research. These considerations are of particular importance in the outpatient community oncology setting, where the demands for clinical productivity and evidence for quality and effectiveness are increasing amidst an evolving reimbursement system.

Oncology clinicians administer monoclonal antibodies (MoAbs) as part of the armamentarium against cancer. Nurses are skilled in the management of general treatment-related symptoms and are knowledgeable regarding the care of patients receiving these therapies. New therapies require expanded knowledge bases regarding unique and selective side effects, such as those seen with targeted therapy agents.

Angiogenesis is the process of new blood vessel growth. In malignant tumors this process is essential for the delivery of needed nutrients and oxygen for the continued growth and survival of cancer cells. Thus the process of angiogenesis and the subsequent development of therapies that inhibit the process have generated great interest since Judah Folkman's original hypothesis was presented over 3 decades ago. Folkman's studies in the 1970s sparked interest in the science of angiogenesis and led to the first specific therapy to inhibit angiogenesis, but it was not until 2004 that the first antiangiogenesis agent, bevacizumab (Avastin), was approved by the US Food and Drug Administration (FDA) in combination with chemotherapy. Since then, two multitargeted or dual action oral agents have been FDA-approved. Advances have also been made in understanding the science of antiangiogenesis, which has contributed to the design of agents as well as clinical trials in the treatment of several tumor types and is being studied actively in many others.

About 6% of colorectal cancers are caused by genetic mutations associated with hereditary colorectal cancer syndromes. The most common hereditary cancer syndromes nurses are likely to encounter include hereditary nonpolyposis colon cancer or Lynch syndrome, familial adenomatous polyposis, attenuated familial adenomatous polyposis, and MYH polyposis. Current colorectal cancer recommendations for risk management, screening, and surveillance are complex and based on level of colorectal cancer risk and whether an individual carries a genetic mutation associated with a hereditary colorectal cancer syndrome. Caring for patients with hereditary colorectal cancer syndromes requires nurses to understand how to identify individuals and families at risk for hereditary colorectal cancer, refer to appropriate resources, and provide accurate information regarding screening, surveillance, and management. Nurses play a critical role in assessing colorectal cancer risk, obtaining an accurate family history of cancer, and providing information concerning appropriate cancer screening and surveillance.