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Interventions to Improve Adherence and Symptoms for Oral Agents
Oncology Nursing Society (2011)
  • Sandra Spoelstra, Grand Valley State University
Significance & Background:
With increased use of oral chemotherapy agents to treat cancer, patients are responsible for adhering to complex dosing regimens and to self-monitor symptoms.
This study determined through a three arm trial of 119 patients with solid tumors from four Cancer Centers, how an Automated Voice Response (AVR) system alone (n=40), or the AVR complemented by nurse strategies to manage symptoms and adherence (n=40), or to manage adherence alone (n=39), reduced symptom severity and non-adherence to oral chemotherapy.
Conceptual Framework:
This trial compared an educational approach to symptom management coupled with reminders to take medications with cognitive behavioral models: one focused on nurse directed strategies managing symptoms/adherence, and the other adherence only.
Methods & Analysis:
Participants received the Symptom Management Toolkit® then participated in an interview for severity of 15 symptoms, satisfaction, and belief about oral agents then randomized into 3 arms. Patients received 8 weekly AVR calls; and some had 1-2 nurse calls for behavioral self-management if severity for any symptom was above threshold and/or adherence was <100%. Exit interviews were at 10 weeks.
Findings and Implications:
The sample consisted of 37 men and 82 women, age 28 to 86, and 76% Caucasian.  Mean symptom severity intake/exit differed by arm: AVR alone—16/11; AVR nurse strategies to manage symptoms and adherence—18/12; and managing adherence alone—22/20. 33% non-adherence occurred, with similarity among arms. Missed medication doses increased with regimen complexity: continuous cycle, 10% non-adherent and 2% over-adhered; 14 days on/7 days off 16% non-adherent and 48% over-adhered; 7 days on/7 off, 67% over-adhered. Many patients mistook >3 doses, 12.3% for the 28 day on cycle, 60% for the 14 days on/7 days off, and 66.7% for the 7 days on/7 off. 19 of 45 medication stoppages were not doctor recommended. The AVR alone was just as effective at managing symptoms and adherence as AVR plus nurse strategies. Complexity of the medication regimen influenced adherence. Interventions need to focus on clinicians eliciting patient feedback on adherence, simplifying the regimen (days on and off), identifying medication reminders, developing symptom management techniques, and patient education on the value of oral agents for efficacy of cancer treatments relationship to adherence.
Publication Date
Spring 2011
Citation Information
Sandra Spoelstra. "Interventions to Improve Adherence and Symptoms for Oral Agents" Oncology Nursing Society (2011)
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