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Symptom Severity, Symptom Attribution, and Preference for Assistance While Taking Chemotherapy or Targeted Agents
Oncology Nursing Society (2013)
  • Sandra Spoelstra, Grand Valley State University
Significance: When taking oral agents, patients need to manage symptoms so that they do not become so severe that it leads to decreased function and difficulty with activities of daily living, and reducing or stopping the medication, rendering the cancer treatment ineffective.
Problem & Purpose: Over fifty oral anti-cancer agents are currently on the market, and within three years, 25% of treatment will be delivered in pill form, shifting treatment to the responsibility of patients. This study describes symptoms from oral agents, attribution of symptoms, and preference for assistance. 
Framework: Not applicable.
Methods: Thirty cancer patients taking oral agents from six cancer centers were interviewed via phone at baseline, weekly for three weeks, and at week eight. Information on cancer site, stage, treatment, symptom severity, comorbidities and medications, symptom attribution, and preference for obtaining help to manage cancer treatment related symptoms were obtained. Confidence intervals on preferences were conducted using exact method. Associations between preferences, attribution to cancer, treatment, comorbidities, and characteristics were explored; and generalized estimating equations examined associations between symptoms and other factors.
Findings: Mean age was 65; 50% each Female/Male; 83% Caucasian and 17% African American; and 77% had one or more comorbid condition. Nine different oral agents were taken; with 53% on Xeloda. 43% also had IV chemotherapy. Patients had a mean of 5.3 symptoms of 15 assessed, across the assessments. Fatigue (83.3—90.0% across assessments) was most common. Symptom attribution at baseline was 57% to cancer and treatment, 36% to comorbidities plus cancer and treatment, and 7% to only comorbidities; with minimal symptom change over time. Attribution including comorbidities was higher in older, female, African Americans. At baseline, 37% preferred phone calls for symptom management, 27% written material, 23% email, and 3% text messages. No preferences were found by age, gender, race, cancer type, or oral agent. Those with later stage cancer preferred written material (p=.03) and there was a marginal association (p=0.08) in preference for those with comorbidities for phone calls or email. 
Implications: Clinicians need to determine patient preferences, and provide symptom management strategies in the manner in which they will be utilized.
Publication Date
Summer 2013
Citation Information
Sandra Spoelstra. "Symptom Severity, Symptom Attribution, and Preference for Assistance While Taking Chemotherapy or Targeted Agents" Oncology Nursing Society (2013)
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