TARGET AUDIENCE
This activity has been designed to meet the educational needs of oncology nurses, nurse practitioners and clinical nurse specialists involved in the treatment of gastrointestinal (GI) cancer.

OVERVIEW OF ACTIVITY
Cancer of the colon and rectum is the fourth most frequently diagnosed cancer and the second most common cause of death among all neoplasms in the United States, accounting for approximately 9% of all cancer deaths. Although individually less frequently encountered, the collection of other noncolorectal GI cancers account for more per annum cancer-related deaths than those attributed to tumors of the colon and rectum combined. In 2014 in the United States alone it is estimated that these diseases will culminate in 136,830 new cases and 50,310 deaths.

Current therapeutic management of colorectal cancer (CRC) is dependent on tumor stage at the time of initial diagnosis, status of surgical margins, patient performance status, age, prior treatment exposure and sites of metastasis for those with disease recurrence or de novo advanced cancer. Although these variables are helpful in guiding selection of treatment, the introduction of novel biomarkers, multigene signatures and molecular-targeted systemic agents has significantly refined the clinical algorithm such that individualized therapeutic approaches have become the standard. Similarly, local and systemic treatment approaches for each of the non-CRC GI cancers are continuously evolving. Like their more prevalent tumor counterparts, the impact of novel molecular-targeted and biologic therapies on the management of non-CRC GI cancers has been profound. The availability of multiple recently approved treatment options with novel and complex mechanisms of action reinforces the pivotal position of nurses as caregivers, communicators and educators, as they play an integral role in the successful delivery of systemic anticancer therapy and the preservation of patient physical and psychosocial well-being.

These video proceedings from the sixth part of a 6-part integrated CNE curriculum originally held at the 2014 ONS Annual Congress feature discussions with leading GI cancer investigators and their nursing counterparts regarding actual patient cases and recent clinical research findings affecting the optimal therapeutic and supportive care for each patient scenario.

PURPOSE STATEMENT
By providing information on the latest research developments in the context of expert perspectives, this CNE activity will assist oncology nurses, nurse practitioners and clinical nurse specialists with the formulation of state-of-the-art clinical management strategies to facilitate optimal care of patients with GI cancer.

LEARNING OBJECTIVES

• Apply existing and emerging research data to the therapeutic and supportive care of patients with metastatic CRC (mCRC), gastric cancer and hepatocellular carcinoma (HCC).
• Describe the clinical impact of and toxicities associated with the use of bevacizumab, EGFR inhibitors, aflibercept and regorafenib for metastatic colon cancer.
• Use clinical characteristics and molecular biomarkers to select optimal treatment strategies for patients with locally advanced or metastatic gastric or gastroesophageal cancer.
• Communicate the benefits and risks of existing and emerging local and systemic interventions to patients with locally advanced or metastatic HCC.
• Identify opportunities to enhance the collaborative role of oncology nurses in the comprehensive biopsychosocial care of patients with mCRC, gastric cancer and HCC to optimize clinical and quality-of-life outcomes.

ACCREDITATION STATEMENT
Research To Practice is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

CME credit is no longer available for this issue

CREDIT DESIGNATION STATEMENT

CME credit is no longer available for this issue

FOR SUCCESSFUL COMPLETION
This is a video CNE program. Participants should read the learning objectives and faculty disclosures and watch the video.

CME credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES
Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CNE activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

Tanios Bekaii-Saab, MD
Section Chief, Gastrointestinal Oncology
Chair, OSUCCC Gastrointestinal Disease Research Group
Associate Professor of Medicine and Pharmacology
The Ohio State University – James Cancer Hospital
Columbus, Ohio

Consulting Agreements: AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Genentech BioOncology, Lilly, Sanofi; Contracted Research: Oncolytics Biotech Inc, Pfizer Inc.

Charles S Fuchs, MD, MPH
Director, Center for Gastrointestinal Cancer
Dana-Farber/Harvard Cancer Center
Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Advisory Committee: Celgene Corporation, Genentech BioOncology, Lilly, Metamark Genetics Inc, Sanofi, Takeda Pharmaceuticals North America Inc; Consulting Agreements: ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Lilly.

Jessica Mitchell, RN, CNP, MPH
Certified Nurse Practitioner
GI Medical Oncology
Mayo Clinic
Rochester, Minnesota

Advisory Committee and Other Remunerated Activities: Bayer HealthCare Pharmaceuticals.

Yahna T Smith, MSN, CNP
Nurse Practitioner
The Ohio State University Comprehensive Cancer Center
Arthur G James Cancer Center
Columbus, Ohio

No real or apparent conflicts of interest to disclose.

MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME/CNE activities from the following commercial interests: AbbVie Inc, Amgen Inc, Astellas, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc, Teva Oncology and VisionGate Inc.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Bayer HealthCare Pharmaceuticals, Genentech BioOncology, Lilly and Onyx Pharmaceuticals Inc.

Hardware/Software Requirements:
A high-speed Internet connection  
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
Adobe Flash Player 10.2 plug-in or later
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio

There is no implied or real endorsement of any product by RTP or the American Nurses Credentialing Center.