Spoelstra, Sandra L., Given, Barbara A., Given, Charles W., Grant, Marcia, Sikorskii, Alla, You, Mei, Decker, Veronica
funding text
This study was supported by a research grant funded by the Oncology Nursing Society Foundation through an unrestricted grant from GlaxoSmithKline. Dr Spoelstra also received funding from the Mary Margaret Walther Behavioral Oncology Group and the State of Michigan Nurse Corp.
abstract
Background: Use of oral chemotherapy agents to treat cancer has increased. Patients are responsible for adhering to complex regimens while managing symptoms from adverse effects of the chemotherapy. Objective: This study examined an intervention to manage symptoms and adherence to oral agents. Methods: A 3-group pilot study determined how an Automated Voice Response (AVR) system alone (n = 40), or the AVR with strategies to manage symptoms and adherence (n = 40), or the AVR with strategies to manage adherence (n = 39) reduced symptom severity and improved adherence. Participants received a Symptom Management Toolkit, completed a baseline interview, and were randomized to receive 8 weekly AVR calls. An exit interview occurred at 10 weeks. Results: Mean age was 59.6 years, with 70% female and 76% white, and 42% were nonadherent, with missed doses increasing with regimen complexity. Symptom severity declined over time in all groups. No difference was found in adherence rates, and higher adherence was related with lower symptom severity across groups. Conclusions: Adherence, a significant clinical problem, can affect efficacy of the cancer treatment. The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from adverse effects. Implications for Practice: Nurses need to focus on patient education by ensuring patient understanding of oral agent regimen and the need to adhere to the oral agent for efficacious cancer treatment. Nurses can promote the use of medication reminders and self-management of symptoms from adverse effects, to support adherence to the oral agent.