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Treatment Options in Advanced CRC

John L. Marshall, MD; Mohamed E. Salem, MD; and Monica Chacha, RN, discuss the roles of the members of the cancer care team and highlight the different treatment options available.
PUBLISHED September 22, 2016


John L. Marshall, MD: So, welcome to Georgetown University Lombardi’s Comprehensive Cancer Center here in Washington, D.C. I’m joined by members of our fabulous team in GI cancer. First, let me introduce Monica Chacha, who’s focused in GI cancer nursing. Welcome.
 
Monica Chacha, RN: Thanks.
 
John L. Marshall, MD: And Dr. Mohamed Salem, who’s one of our new partners here who’s made such an amazing contribution to cancer care and GI cancer patients in general. So, thanks, Mohamed.
 
Mohamed E. Salem, MD: Thank you.
 
John L. Marshall, MD: I just want to give you guys a sense of what the cancer care team is like. Cancer is a really common disease, and in almost every community nearby, there is a so-called comprehensive cancer center. And, what this really means is it’s a team sport. It has all the elements that you need as a colon cancer patient to be cared for. Let’s talk a little bit about all of those key elements. Monica, tell us about some of the important key pieces that have to be there to do the best job to take care of our patients.
 
Monica Chacha, RN: We have a great team, a lot of people that work together. We have the nurses in clinic who are the go-to people. We have the infusion nurses who are going to give people their treatments. They do a lot of education and they also do some symptom management. We have nutritionists, who are excellent, helping you eat while you’re feeling sick or while you’re on treatment to maintain your strength. And then, we have social workers to help with the whole array of different things.
 
John L. Marshall, MD: And those folks are not there all the time, but they’re there at the critical times to help guide and manage. So, on the doctor’s side, what’s the team?
 
Mohamed E. Salem, MD: I think it’s new to most of our patients, so anybody who comes with cancer and never had that experience before. We have to walk them step by step on what cancer means to them, and how it’s going to impact their life. At least at the beginning, there is a lot of discussion that takes place in terms of making them understand the diagnosis, what they have, and also introduce the team members like the nurse navigators, clinic nurses, the dietitians, and the other subspecialties.
 
John L. Marshall, MD: But, almost all these patients have seen a surgeon by the time they come to see us. They’ve seen interventional radiology, the folks who put in Mediports and do biopsies, seen gastroenterology, and radiation oncology. So, all of those folks are needed to put together our team, and we’re just very proud of the team that we have here. We’re seeing almost 1000 new GI cancer cases every year. And I hope that we’re providing our community, as well, with the kind of support that they need when they need this kind of expertise. We partner very tightly with our community physicians to provide the most patients with the best care we can.
 
So, if you’re watching this, you’re either a patient with metastatic colon cancer, or maybe a caregiver or a loved one of a patient with metastatic colon cancer. We’re sorry you’re part of our club, but welcome to the club. We know that we’ve made progress with this disease. We have new medicines, many of which you may have already seen. When I started a long time ago, we really didn’t have very many medicines for the treatment of metastatic colon cancer, and patients did not live very long. And now with our new medicines and our better understanding of how to use them, we’re hoping that you and others like you are living significantly longer. It’s not long enough, we get that totally. We have more work to do going forward, but we have made progress.
 
The balance here is that you’ve got to have been coming in every couple of weeks for chemotherapy. Sometimes you take a pump home. Sometimes there are pills, so there are side effects. And so, it’s very important for all of us in this marathon race of metastatic colon cancer to make sure you keep running. You need to be well enough. You need to feel okay. We need to watch your quality of life. We need to manage your symptoms, side effects, the pain, and all the junk that comes with treatment for metastatic colon cancer.
 
Now, most patients have gone through an initial line of therapy maybe with a drug called oxaliplatin, or another line of therapy with a drug called irinotecan. But, there are two new medicines that work. They’re oral medicines. One is called Stivarga and one is called Lonsurf. They are different, but they both bring benefit to patients with metastatic colorectal cancer. And so, it’s a shift in thinking. These are new chess pieces on the board, if you will, new laps in the marathon. Your physician will be approaching you and talking to you about these medicines. And what we’re really trying to do here is give you some information about these new medicines, how to manage the side effects, how to optimize your quality of life, and how to optimize your energy as you continue on in the marathon race that is metastatic colon cancer.
 

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