Tools You Can Use
The online tools described below are available to help oncology nurses assess patients’ CRC risk and facilitate treatment decisions.
Patient Assistance Programs
Reimbursement issues are often a challenge due to the high cost of cancer treatment. Patient assistance programs through pharmaceutical companies are available to
- Assess insurance coverage
- Review billing processes to maximize reimbursement
- Assist those unable to afford the drugs
Because patients may not be able to navigate through these programs, health care professionals will benefit from becoming acquainted with them.
The Partnership for Prescription Assistance (PPA)
Internet: https://www.pparx.org/Intro.php
Phone: 1-888-4PPA-NOW (1-888-477-2669)
This is the first stop in exploring options for patient assistance reimbursement programs. The mission of the PPA is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. This program offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. It brings together US pharmaceutical companies, doctors, other health care providers, patient advocacy organizations, and community groups to help qualifying patients who lack prescription coverage to get medicines they need through public or private programs appropriate for their treatment needs. Medications may be available free of charge or for a small fee.
In 2007, the Pharmaceutical Research and Manufacturers of America (PhRMA), comprising 1,300 member pharmaceutical groups, joined with PPA to discuss ways in which the public and private sectors can work together to identify the best practices in helping the uninsured. More about this partnership is available at www.phrma.org.
Pharmaceutical Companies
Most pharmaceutical companies have hotlines or reimbursement programs to assist patients in acquiring necessary drug treatment. The following table lists specific treatment and supporting agents for patients with colorectal cancer (CRC). It is intended for US residents only.
| Specific Treatment and Supporting Agents for Patients with Colorectal Cancer (CRC) | |||
| Adjuvant and metastatic CRC treatment |
|||
| 5-FU/leucovorin | GlaxoSmithKline For You |
(866) 475-3678 |
website Updated 2007 |
| Irinotecan (Camptosar®) | Pfizer Oncology, FirstRESOURCE |
(877) 744-5675 |
website Updated 2003 |
| Oxaliplatin (Eloxatin®) | sanofi-aventis, PACT+ Program |
(800) 996-6626 |
website Updated 2007 |
| Capecitabine (Xeloda®) | Roche Oncoline Patient Assistance Program |
(800) 443-6676 (option 3) |
website Updated 2007 |
| Cetuximab (Erbitux®) | Bristol-Myers Squibb Destination Access |
(800) 861-0048 |
website Updated 2005 |
| Bevacizumab (Avastin®) | Single Point of Contact (SPOC) Avastin Patient Assistance program |
(888) 249-4918 |
website Updated 2007 |
| Panitumumab (Vectibix®) | Amgen Oncology Assistance |
(800) 272-9376 |
website Updated 2007 |
| Supportive care Nausea | |||
| Granisetron (Kytril®) | Roche Oncoline Patient Assistance Program |
(800) 443-6676 (option 2) |
website Updated 2007 |
| Dolasetron (Anzemet®) | sanofi-aventis, PACT+ Program |
(800) 996-6626 |
website Updated 2007 |
| Ondansetron (Zofran®) | GlaxoSmithKline Reimbursement Resource Center |
(800) 745-2967 |
website Updated 2007 |
| Palonosetron (Aloxi®) | MGI Pharma Access Program (MAP) |
(877) 644-6270 |
website Updated 2006 |
| Aprepitant (Emend®) | Merck Accessing Coverage Today (ACT) |
(866) 363-6379 |
website Updated 2007 |
| Growth factors | |||
| Filgrastim (Neupogen®) and Pegfilgrastim (Neulasta®) | Amgen Reimbursement Connection |
(800) 272-9376 |
website Updated 2007 |
| Erythropoiesis-stimulating agents (ESA) | |||
| Epoetin alfa (Procrit®) | Ortho Biotech PROCRITline.com |
(800) 553-3851 (option 3) |
website Updated 2007 |
| Darbepoetin alfa (Aranesp®) | Amgen Reimbursement Connection |
(800) 272-9376 |
website Updated 2007 |
A Patient’s Guide to Colorectal Cancer Treatment
(DVD Program) is a comprehensive resource for oncologists and oncology nurses to give to patients with colorectal cancer and their families. Dr. John Marshall, Chief, Division of Hematology/Oncology, Lombardi Comprehensive Cancer Center Georgetown University, explains the disease, the treatment options and what to expect during chemotherapy. Videos featuring interviews with colorectal cancer patients and their medical team highlight the importance of good communication throughout treatment which helps to minimize side effects and improve quality of life. Information is available at: http://cancernetwork.com/dvd/coldvd.htm?cid=CN-COAB-PROMO-030807
TO OBTAIN INDIVIDUAL OR BULK COPIES AT NO CHARGE
Call toll free 1-800-444-4881 or e-mail your request to: orders@cmp.com. Please identify this program as Colorectal DVD and let us know where you saw the offer. Limit 20 per order.
See CE Links for the professional edition New Treatment Paradigms in Colorectal Cancer.
Pocket Guide
Pocket Guide to Colorectal Cancer: Drugs and Treatment, by Gail M. Wilkes, RNC, MS, AOCN
This 130-page 5 x 3-inch booklet is a valuable resource for nurses caring for patients with CRC in all clinical and home settings. The booklet includes epidemiology of CRC, along with staging, medical and surgical management, adjuvant and advanced treatment options, chemotherapeutic agents, and approaches to patient education. Ms Wilkes, a nurse practitioner from Boston, is well known and published in the area of CRC.
To purchase a copy of the pocket guide, contact the publisher, Jones and Bartlett, through its Web site at http://www.jbpub.com. For membership in its affiliate program, check http://www.jbpub.com/cart2004/associate/overview.cfm..
Lynch Syndrome Prediction Models
A model developed by investigators at Dana-Farber Cancer Institute assists clinicians in
- Estimating the likelihood of individual patients carrying mutations in the MLH1 or MSH2 genes. These mutations are the primary causes of hereditary nonpolyposis CRC (also known as the Lynch syndrome).
- Determining which patients would derive the greatest benefit from molecular evaluation and genetic testing The investigators who developed the model
- Created a questionnaire based on findings of a 5-year study of clinical and genetic data from nearly 2,000 patients1
- Determined that personal and family medical histories reliably predict an individual's chances of harboring mutations in the cancer-related genes
The model is available at http://www.dana-farber.org/pat/cancer/gastrointestinal/crc-calculator/.
A second model, MMRpro, also based on personal and family history and tumor characteristics, predicts mutations in the MSH6, MLH1, and MSH2 genes. Developed at Johns Hopkins Bloomberg School of Public Health, the cohort included 279 germline-tested individuals.2 The MMRpro model is available at http://astor.som.jhmi.edu/BayesMendel.
Treatment Decision Models
Treatment decisions can be difficult for clinicians and patients, and several models assist in this process.
Adjuvant!Online
In the adjuvant CRC setting, this model
- Uses information from the patient’s surgical and pathological reports to project the net benefit of adjuvant therapy for CRC
- Estimates overall survival and risk of relapse at 5 years3
- Does not make specific therapeutic recommendations, but supplies information that may be useful in deciding among adjuvant options
- Identifies required patient characteristics for analysis under General Information About Adjuvant! in the colon cancer online documentation section of the site.
The model is available at http://www.adjuvantonline.com. The site provides Palm and PocketPC versions for downloading. Use of the model requires free registration. Although its use is not restricted to health care professionals, the authors suggest that health care professionals enter the patient’s information, print out the reports, and discuss the recommendations with the patient and family.
OncoSurge
Surgical options for patients with possibly resectable hepatic metastases can be evaluated through this online model, available at http://www.kgu.de/alm/oncosurge/index.htm. This model identifies individual patient resectability and recommends optimal treatment strategies.4 The overall goals of OncoSurge are
- Identify patients for whom liver resection may lead to a cure or render unresectable liver metastases resectable
- Make recommendations based on an expert advisory panel available to health care specialists in CRC surgery and treatment
Clinical cases for medical education are available. No registration is required.
Treatment Option Tools for Patients
NexProfiler Tool for Cancer
The American Cancer Society provides this free, interactive decision assistance model, designed for patient use and available at http://www.cancer.org/profiletools. Free registration, with an e-mail address (to be used as the user name) and a password, is required. The NexProfiler Tool for Cancer
- Enables cancer patients and their physicians to make better-informed treatment decisions using information from evidence-based, peer-reviewed medical literature
- Provides treatment decision tools for a variety of cancer types, including CRC
Patients wishing to use the tools will need to
- Have their pathology report available, for entry of specific histologic information
- Complete an in-depth questionnaire that includes diagnosis, treatments undertaken, comorbid conditions, and test results
The NexProfiler technology matches the clinical parameters against a medical database and returns the relevant research information, which is scientifically validated and drawn from published medical literature. Patients can revisit the site as treatment progresses, to update their clinical information, learn more about their evolving treatment options, and review newly published information. NexProfiler information is maintained by NexCura, a division of Thomson Healthcare, is based on scientific medical journals, and is continuously updated by experts in cancer research and treatment.
References
- Balmaña J, Stockwell DH, Steyerberg EW, et al. Prediction of MLH1 and MSH2 mutations in Lynch syndrome. JAMA. 2006;296:1469-1478.
- Chen S, Wang W, Lee S, et al. Prediction of germline mutations and cancer risk in the Lynch syndrome. JAMA. 2006;296:1479-1487.
- Gill S, Loprinzi CL, Sargent DJ, et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol. 2004;22:1797-1806.
- Poston GJ, Adam R, Alberts S, et al. OncoSurge: a strategy for improving resectability with curative intent in metastatic colorectal cancer. J Clin Oncol. 2005;23:7125-7134.
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