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Symptom Severity, Attribution, & Preference for Assistance While Taking Chemotherapy or Targeted Agents Sandra Spoelstra, PhD, RN 1 ; Barbara Given, PhD, RN, FAAN 1 ; Monica Schueller, BA 1; Kimberly Ridenour, Nurse Scholar 1 ; Melissa Hilton, RN 1 ; Zhiying You, MS 1 ; and Charles W. Given, PhD 2 Sample Mean Age: 65 (range: 48-83) with 50% Female/Male 87% Caucasian & 13% African American 30% Colon; 13% Leukemia; 10% Breast; 7% Ovarian; & 40% Other Cancer Stages: II–3%; III–10%; IV–60%; Not Staged–27%; Oral Agents: Xeloda–53%; Revlimid–10%; Etopside– 10%; Gleevec–7%; Other – 20% 1 College of Nursing 2 College of Human Medicine, Department of Family Medicine. This work was supported by the Walther Foundation, Indianapolis, IN. Problem Over 50 oral anti-cancer agents are on the market, and within three years, 25% of treatment will be delivered in pill form, shifting treatment to the responsibility of patients. 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. Design and Method This 8-week exploratory study of cancer patients on oral agents from 3 cancer centers in the Midwest describes symptoms, attribution, and preference for assistance. Baseline interviews collected characteristics, type and stage of cancer, symptom severity, and comorbid conditions, and preference for information to help manage symptoms. Fisher’s exact test examined relationships among the factors. Implications for Nursing Practice Understanding preference for symptom management strategies will enable nurses to deliver the information in a manner in which the patients can use them to minimize or eliminate bothersome symptoms. The goal is to prevent the symptoms from becoming so severe that it leads to reducing or stopping the oral agent, thus, rendering the cancer treatment ineffective. Therefore, use of both written and verbal communication is needed. Symptoms & Comorbid Conditions Symptom: 83% (N=25) fatigue & pain; 63% (N=19) numbness or tingling; 53% (n=16) sleep disturbance; 40% (n=12) diarrhea; 37% (n=11) distress & swelling of hands and feet; 33% (n=10) lack of appetite & shortness of breath; 30% (n=9) red/swelling/pain in hands/feet; 23% (n=7) constipation; 20% (N=6) skin rash/sores & nausea/vomiting; and 17% (N=5) sores in mouth Comorbid conditions: 23% (N=7) had none; and 77% (N=23) had one or more comorbid condition. Medications for comorbid conditions: 60% (N=14) of those with a comorbidity took medications for their comorbid conditions. Attribution: Older, female, African Americans were more likely to attribute symptoms to both cancer and comorbidities. Results Preference for symptom management information: 37% Phone calls (30% land-line, 7% cell phone) 27% Written material 23% Email 3% Text message 10% Other Majority preferred written information. No difference in preference by age, gender, or race No difference in preference by type of cancer, type of oral agent or other treatment (IV chemo and radiation) Later stage cancer preferred written material (p=.03) There was a marginal association (p=0.08) in preference for those with comorbid conditions for land line phone calls or email, but not written materials or text messages.
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