The mainstay of treatment for colorectal cancer (CRC) is chemotherapy, however side effects can lower quality of life, lead to unscheduled medical visits and interfere with drug administration. Through medication reconciliation, regimen-specific risk assessment, patient education, supportive care review, symptom monitoring and pharmacovigilance, clinical pharmacists can promote safer treatment. This narrative review summarizes research on the management, early identification and prevention of significant toxicities linked to irinotecan, oxaliplatin and fluoropyrimidines. Additionally, it takes into account patient-reported symptoms, pharmacogenetic risk assessment and the differentiation between clinical interventions recommended by guidelines and results attributed to services provided by pharmacists. Although demographics and outcome metrics are diverse and there is still no direct data specific to colorectal cancer, evidence from oncology pharmacy research suggests benefits for medication-related procedures. Pretreatment evaluation, cycle-based monitoring, triage and intervention, documentation and pharmacovigilance and reassessment comprise the five stages of the suggested closed-loop practice framework. Review completion, medication-related issue resolution, severe toxicity, urgent care use, treatment change and patient-reported symptom burden are all recommended evaluation metrics. The framework is a suggested practice model rather than a proven intervention; in order to determine its viability, resource needs and clinical efficacy, prospective study is necessary.
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