As cancer treatment in pill form transforms how care is delivered, a new Michigan State University study underscores the challenges patients face in administering their own chemotherapy outside the supervised environment of a cancer clinic.
Chemotherapy pills can target specific cancers better than some traditional intravenous drugs, said Sandra Spoelstra, the MSU assistant professor of nursing who led the study. But they also can be difficult for patients to take.
"Prescriptions for some oral pills have complex instructions," she said. "Some of them require patients to take pills several times a day or cycle their doses, taking one pill a day for three weeks, then stopping for a week before starting again. And some patients take two types of pills to treat their cancer or have multiple medications for other chronic conditions. It can be very complicated."
In addition, side effects such as severe nausea, vomiting, diarrhea, fatigue, skin reactions and pain are common. Those symptoms can lead some patients to skip doses, which may render their cancer treatment ineffective.
During the study, published in the journal Cancer Nursing, more than 40 percent of participating patients took too many pills or missed doses with poor adherence more likely among those with complex treatment regimens.
The researchers randomly assigned the patients to one of three groups. Members of the first group only had help from an automated calling system, developed at MSU, to see if they were following their prescriptions and help them monitor and manage symptoms. The second group got the automated calls and follow-up calls from nurses with strategies for sticking to their pill regimen. The rest got automated calls and nurse advice on both adhering to their regimen and managing symptoms.
Patients in all three groups reported less severe symptoms at the end of the study. The automated calls were just as effective alone as when they were coupled with nurse guidance. That suggests the automated system could be a simple and inexpensive way to help some patients take their drugs properly, Spoelstra said.
The small study will be the springboard for more comprehensive research that may yield clearer lessons for health care professionals, said University Distinguished Professor Barbara Given, who co-authored the study and leads the College of Nursing's efforts to improve oral chemotherapy.
In the meantime, she said nurses should be attentive when explaining oral chemo regimens to be sure patients and their families understand how to take the drugs as prescribed.
"It's cutting-edge treatment, but we don't know enough about it yet," she said. "People think if they had a life-threatening disease and their doctor recommended treatment, they'd follow the recommendations. But it's really not that simple."
- Sandra L. Spoelstra, Barbara A. Given, Charles W. Given, Marcia Grant, Alla Sikorskii, Mei You, Veronica Decker. An Intervention to Improve Adherence and Management of Symptoms for Patients Prescribed Oral Chemotherapy Agents. Cancer Nursing, 2013; 36 (1): 18 DOI: 10.1097/NCC.0b013e3182551587
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