Joe is a 54-year-old man with metastatic colorectal cancer who has been receiving treatment at the cancer center for the past three years.

He has had surgery and chemotherapy, including oxaliplatin, irinotecan, 5-fluorouracil, and cetuximab, although he’s not currently receiving chemotherapy now. He and his long-term girlfriend, who is very supportive, have a 16-year-old daughter who sometimes comes to appointments but most often is in school. He is disabled and has Medicare as his insurance coverage. Joe has been slowly losing weight, and it seems his spirits are low. He has missed one appointment, and Mary, his nurse, is hoping he will show up for his visit today.

What Would You Do?

The cancer center has a stage II trial, which is investigating nintedanib plus capecitabine for patients with refractory colorectal cancer. Mary and the oncologist plan to discuss this option with Joe today. Both practitioners agree that this may give him some hope because the trial has had some preliminary good results.

Joe and his girlfriend arrive for the appointment and watch Mary expectantly as she takes a history, finding out what has happened in the past two months. Joe says that he has lost two to three more pounds, has no appetite, and has difficulty finding things to do during the day. He wonders if he should start chemotherapy again. His most recent scans show the cancer to be stable.

As Joe’s nurse, Mary knows that “clinical trials are essential for the development of new and effective treatments. But for trials to produce valid and generalizable results, effective accrual of participants is necessary. Unfortunately, rates of participation in adult cancer clinical trials in the United States of America are very low.”

Together, Mary and the physician offer the option of a clinical trial, namely nintedanib. Joe seems excited about taking something new, but his girlfriend has many questions about the medication, especially what happens if it doesn’t work for Joe. Knowing that patients need to fully understand the trial, including that they can stop participating at any time, Mary takes the time to make sure Joe and his girlfriend have all of their questions answered about the proposed clinical trial.

Joe’s girlfriend asks for some time to discuss this option with Joe, outside of the office, and Mary agrees that this is a good idea. Knowing that Joe’s cancer is stable for now, she schedules a follow-up appointment in approximately 10 days. She also gives them a referral to speak with the research staff and makes the introduction before they leave the office. Finally, Mary asks Joe and his girlfriend if they would like to speak with a social worker they have met before to explore the possibility of depression.