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

Spoelstra, Sandra L. PhD, RN; Given, Barbara A. PhD, RN, FAAN; Given, Charles W. PhD; Grant, Marcia DNSc, RN, FAAN; Sikorskii, Alla PhD; You, Mei MS; Decker, Veronica MS, RN

doi: 10.1097/NCC.0b013e3182551587

Background: 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.

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

Methods: 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.

Results: 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.

Conclusions: 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.

Implications for Practice: 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.

Author Affiliations: College of Nursing (Drs. Spoelstra and B. A. Given and Ms You), Department of Family Medicine (Dr C. W. Given), and Department of Statistics and Probability (Dr Sikorskii), Michigan State University, East Lansing; City of Hope National Medical Center, Duarte, California (Dr Grant); and Florida Hospital Cancer Institute, Orlando (MsDecker).

This study was supported by a research grant funded by the Oncology Nursing Society Foundation through an unrestricted grant from GlaxoSmithKline. Dr Spoelstra also received funding from the Mary Margaret Walther Behavioral Oncology Group and the State of Michigan Nurse Corp.

The authors have no conflicts of interest to disclose.

Correspondence: Sandra L. Spoelstra, PhD, RN, College of Nursing, Michigan State University, 417B Fee Hall, East Lansing, MI 48824 (

Accepted for publication March 10, 2012.

© 2013 Lippincott Williams & Wilkins, Inc.