Two and a half years ago one of my best friends, who is a physician, was diagnosed with colorectal cancer metastatic to the liver at age 54. No, she hadn't undergone colorectal cancer screening. Not because she didn't know better. Not because she didn't understand. Not because she didn’t have health insurance. But because life got in the way, as it does for so many of us. She was too busy – with her work and her family. She didn’t have the time.
Thirty-five years ago, when I was a new oncology nurse, the importance of colorectal cancer screening, the natural history of adenomas and their relationship with colorectal cancer were not yet understood. My friend would have received the standard first-line therapy for metastatic colorectal cancer with the only 2 drugs we had in our armamentarium at that time – 5-fluorouracil and leucovorin. She would have died of her disease within a year.
Today the standard first-line therapy for metastatic colorectal cancer has progressed from 5-fluorouracil and leucovorin. There are now 8 active and approved drugs for patients with metastatic colorectal cancer: 5-FU, capecitabine, irinotecan, oxaliplatin, bevacizumab, cetuximab, aflibercept and panitumumab. And multiple combination chemotherapy regimens including FOLFIRI, FOLFOX, CAPOX, and FUOX. Patients may receive bevacizumab in addition to FOLFIRI or FOLFOX. But patients with mutant KRAS tumors may experience worse outcome when cetuximab is added to chemotherapy regimens containing bevacizumab.
How do we know all of this? It’s due to clinical research and clinical trials. It’s due to the physicians that take the time to offer clinical trial participation to eligible patients. It’s due to the research nurses, data managers, statisticians and research associates who help with the trials. And it’s due to the willingness of patients to be participants.
Today my friend is disease-free. She’s the reason why many people, including myself, found the time to get screened for colorectal cancer. And why for me March is Colorectal Cancer Awareness month.
Do you discuss advances made through clinical research, such as those described above, when you talk with your patients about clinical trial participation? Why or why not?