Gastrointestinal malignancies consist of a wide range of diseases. In each phase — screening, treatment, and survivorship — we are presented with several challenges and a broad range of options or opportunities for improvement. Colorectal cancer is the fourth most diagnosed cancer in the United States, representing 8% of new cancer cases each year; the other GI malignancies represent another 9% of all cancer cases.1
Established screening guidelines are available for colorectal cancers. Guidelines recommend colonoscopy every 10 years, flexible sigmoidoscopy every 5 to 10 years, or circulating tumor cell (CTC) testing every 5 years, from age 50 to 75 years.2 The role of nurse navigators in GI cancers is to educate the public about screening, explore the myths and barriers that prevent people from undergoing screening, support sharing a diagnosis with family members and orient them to determine their own risk, and advocate for access to procedures and proper logistics.
Treatments have remained the same over the last few years; however, advances have been made in the immuno-oncology space for various GI malignancies. Next generation sequencing is indicated when standard of care options are exhausted or to determine clinical trial eligibility.3 A major change in drug indication for all microsatellite instable (MSI) tumors highlights the need for further coordination in tissue testing.4 Tumor circulating DNA assays are available but have minimal explicit guidelines in GI cancers. The nurse navigator should understand the minimal requirement for testing, have a minimal understanding of the basic principles of tissue allocation, know their institution’s tissue retention policy, and understand payor coverage for testing outside of guidelines.
Lifestyle changes (eg, daily exercise, varied diet, limit alcohol use, and tobacco use cessation) and support throughout the survivorship phase can make a significant impact. They can make a difference not only on quality of life, but also in the quality of response to treatment as shown by large dataset about nut consumption, for example 5. Navigators should provide patients with a survivorship care plan that includes a complete summary of treatment; late effects and signs of recurrence to watch for; and a precise timeline for follow-up, including imaging and labs.
GI cancers have a very heterogeneous behavior and evolving screening principles. An essential role for the navigator is to initiate tangible interventions that can maintain quality of life through disease progression.
1. Cancer Stat Facts. National Cancer Institute website. https://seer.cancer.gov/statfacts/. Accessed June 11, 2019.
2. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Colorectal cancer screening. Version 1.2018 — March 26, 2018. https://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. Accessed June 7, 2019.
3. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Genetic/familial high-risk assessment: colorectal. Version 1.2108 — July 12, 2018. https://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf. Accessed June 7, 2019.
4. Stenger M. Pembrolizumab in MSI-H or dMMR solid tumors: ‘first tissue/site-agnostic’ approval by FDA. The ASCO Post website. http://www.ascopost.com/issues/february-10-2018/pembrolizumab-in-msi-h-or-dmmr-solid-tumors-first-tissuesite-agnostic-approval-by-fda/. Accessed June 7, 2019.
5. Fadelu T, Zhang S, Niedzwiecki, et al. Nut consumption and survival in patients with stage III colon cancer: results from CALGB 89803 (Alliance). J Clin Oncol. 2018;36(11):1112-1120.