An Intervention to Improve Adherence and Management of Symptoms for Patients Prescribed Oral Chemotherapy Agents An Exploratory Study

City of Hope National Medical Center, Duarte, California (Dr Grant)
Cancer nursing (Impact Factor: 1.97). 01/2013; 36(1):18-28. DOI: 10.1097/NCC.0b013e3182551587
Source: PubMed


: 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.
: This study examined an intervention to manage symptoms and adherence to oral agents.
: 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.
: 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.
: 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.
: 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.

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Available from: Sandra L Spoelstra, Nov 30, 2015
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    • "The Toolkit is a bound notebook of evidence-based information that discusses what is needed to manage the OA medication safely, adherence to the regimen, and common side effects from the cancer or cancer treatment. The Toolkit has been used to promote symptom management in several studies and is well accepted by patients (Given, Given, & Sikorskii, 2007; Spoelstra et al., 2013b). "
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    ABSTRACT: Purpose/objectives: To determine proof of concept of a mobile health (mHealth) intervention delivering text messages (texts) to self-manage among patients prescribed oral anticancer agents (OAs) and to examine preliminary efficacy on symptoms and medication adherence. . Design: A longitudinal randomized, controlled trial. . Setting: Two community cancer centers in the midwestern United States and a national specialty pharmacy. . Sample: 80 adults with cancer who were newly prescribed OAs. . Methods: Adherence and symptoms were assessed weekly for 10 weeks in both groups. The intervention group received daily texts for adherence and weekly for symptoms for 21-28 days, and satisfaction with the intervention was assessed. . Main research variables: Medication adherence and symptom severity. . Findings: Mean age was 58.5 years (SD = 10.7 years), 48 participants were female, and 48 were Caucasian. Fewer symptoms were found in the intervention group with a moderate effect size. Adherence was higher in the text group using medical record and prescription data (n = 26) with greater relative dose intensity of moderate to large effect size. Regarding acceptability, 57% (83 of 145) of eligible participants consented, 39 of 40 participants completed the entire intervention, 30 participants read texts all of the time, and 34 participants were satisfied with the intervention. . Conclusions: Proof of concept and preliminary efficacy of an mHealth intervention using texts to promote self-management for patients prescribed OAs was demonstrated. Patients had high satisfaction with the texts, and adherence and symptoms improved after the intervention. . Implications for nursing: Texts show promise for patients with cancer who must manage their OAs. Additional research is needed prior to use in practice. .
    Full-text · Article · Oct 2015 · Oncology Nursing Forum
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    • "reased over time . For example , the adherence rate for Xeloda was 87% for cycle 1 but dropped to 78% for cycle 2 ( MacIntosh et al . 2007 ) . In the Khandelwal et al . ( 2012 ) study , the adherence was from 99% at 1 month to 64% at 3 months and 43% at 6 months . Among the most frequent intake errors was over - adherence , which ranged from 20% ( Spoelstra et al . 2013 ) to 44% ( Mayer et al . 2009 ) . Completely stopping treat - ment was rare , with a rate of 4% in the Lebovits et al . ( 1990 ) study . Finally , we have little information about the long - term effect of chemotherapy used for chronic con - ditions , such as chronic leukaemia . Indeed , Moon et al . ( 2012 ) showed that 92% of patients"
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    ABSTRACT: Since the 1990s, oral chemotherapy has been gaining ground as cancer treatment. This therapy seems to have few toxic effects and offers patients good quality of life. However, in addition to the fears the therapy might generate in patients, oral treatment raises a new issue, which, until now, has been marginal in this field: therapeutic observance or adherence. We investigated the research into adherence to oral chemotherapy among cancer patients published between 1990 and July 2013. Studies showed considerable diversity in terms of both the definition and measurement of adherence. As well, adherence to antineoplastic therapy is affected by the patient's understanding of the treatment and ability to remember information provided by the physician, treatment length and psychological distress. Our review of the few studies on adherence to anticancer drug treatment raises some questions that could be pursued in future research. In light of our findings, patients should receive 'therapy education' to help them and their support groups better understand the disease and its treatment and to achieve optimal health management and improved treatment effectiveness.
    Full-text · Article · Sep 2013 · European Journal of Cancer Care
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    • "Several studies examined interventions to improve adherence to OAMs with others underway. Spoelstra et al. (2013) developed a nursing intervention to improve adherence using a Symptom Management Toolkit ® , based on a modified health belief model approach, and an automated voice response (AVR) reminder system. Participants were randomized to one of three groups: (AVR) system alone (n=40), AVR with strategies to manage symptoms and adherence (n=40), or AVR with strategies to manage adherence (n=39). "
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    ABSTRACT: The use of targeted oral anticancer medications (OAMs) is becoming increasingly prevalent in cancer care. Approximately 25-30% of the oncology drug pipeline involves oral agents and there are now over 50 OAMs approved by the Food and Drug Administration. This change represents a major shift in management of patients with cancer from directly observed, intermittent intravenous therapy to self-administered, oral chronic therapy. The increased prevalence of OAMs raises the issue of adherence in oncology, including understanding the challenges of adherence to OAMs. This review focuses on studies of adherence for patients taking molecularly targeted OAMs for breast cancer, chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GIST), non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). We then discuss barriers to adherence and studies performed to date testing interventions for improving adherence. Finally, we discuss future areas of investigation needed to define and improve adherence to OAMs in targeted therapy for cancer.
    Full-text · Article · Apr 2013 · Discovery medicine
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