Oncology Nursing in a New Era: Optimizing Treatment With Bevacizumab

Abstract

Overexpression of vascular endothelial growth factor (VEGF) by tumor cells promotes angiogenesis, which correlates with progressive tumor growth and poor outcomes in many types of cancer. Bevacizumab inhibits VEGF to promote regression of tumor vessels by limiting blood supply and tumor growth, enhancing delivery of chemotherapy, and inhibiting formation of new vessels. Combined with chemotherapy, bevacizumab prolongs progression-free and overall survival over chemotherapy alone in patients with metastatic carcinoma of the colon and rectum; unresectable, locally advanced, recurrent or metastatic non-squamous, non-small cell lung cancer (NSCLC); and metastatic HER2-negative breast cancers (mBC). Side effects, including hypertension, proteinuria, bleeding, arterial thrombotic events, and impaired wound healing, can be clinically significant, particularly in patients with risk factors. To optimize patient outcomes, nurses should understand bevacizumab's role in cancer therapy, recognize symptoms of toxicity, and manage its side effects. This article describes the rationale for bevacizumab in the treatment of metastatic colorectal cancer, NSCLC, and mBC and discusses patient selection, treatment duration, and side-effect management to support the role of oncology nurses in caring for, educating, and enhancing treatment adherence among patients with cancer receiving bevacizumab. Two case studies are presented as examples of the complex scenarios nurses may encounter regarding these issues.

Current nursing practice for patients on oral chemotherapy: a multicenter survey in Japan

“…Patient orientation for oral chemotherapy should be systematically implemented for every patient who initiates this type of therapy. Patient education about the disease, treatment, and symptom management is the role of the oncology nurse [24], and staffing for orientation is important to ensure patients receive the necessary education.…”

Clinical Significance as It Relates to Evidence‐Based Practice

“…The recommendations varied in their level of specificity, from general admonishments for nurses to become more involved in policy making to prescriptive advice with specific recommendations for practical application. Examples of recommendations to guide nursing interventions included recommendations for medication prescribing (Schaffer et al., 2009), treating postsurgical pain (Kokki et al., 2003; Wilson & Helgadottir, 2006), managing medication responses (Bauer & Romvari, 2009; Marrs & Zubal, 2009), and interpreting or implementing protocols, policies, or procedures (Doughty et al., 2006; Farnell et al., 2005; Gilbert et al., 2002; Harrington, 2005; Hogan, 2009; Kurlowicz, 2001; Ruchala et al., 2002; Swanson & Koch, 2010; Zengin & Enc, 2008).…”

Integration of Genomics in Cancer Care

“…This humanized monoclonal antibody binds to vascular endothelial growth factor, a key protein in tumor angiogenesis, thereby inhibiting blood supply to the tumor. Toxicities associated with bevacizumab include bleeding, hypertension, and proteinuria (Marrs & Zubal, 2009). Nurses who understand the mechanism of action and toxicities associated with these therapies are better able to identify and manage adverse reactions promptly.…”