ORLANDO—Women who are on intravenous (IV) chemotherapy regimens for recurrent ovarian carcinoma are at risk for nonadherence or nonpersistence with their treatment. But telephone support by an advance practice nurse (APN) can lower this risk and even boost compliance, a new, nonrandomized study suggests.
“Nonadherence is not just an issue with oral chemotherapy,” said Susan Moore, RN, MSN, ANP, AOCN, of MCG Oncology, Chicago, Illinois, at her poster presentation. “Patients who are on IV regimens can also be nonadherent with their treatment. We think they are adherent because they show up, but often they are nonpersistent, meaning that they stop before the end of a planned regimen. Telephone support is just another way for APNs to do their outreach to patients.”
APNs are challenged to develop programs that support patient adherence and persistence to prescribed cancer therapies, especially therapies for advanced disease. Ovarian cancer is a particularly difficult cancer to treat, Moore noted.
“Patients who are on liposomal doxorubicin may not be completing their full six cycles. Many drop out because of side effects that are not well managed. Patients who are on this drug have usually been on other chemotherapies before, so they already know the drill,” she said. “They’re not having a very good quality of life. Sometimes patients are afraid or embarrassed to call their nurse or their doctor to tell them they want to quit. Instead, they just don’t come back.”
This study evaluated the efficacy of an APN-staffed telephone patient-support program in increasing adherence to IV chemotherapy in this setting. Participants in the program received a telephone call from an oncology APN before and after each chemotherapy infusion for up to six cycles to reinforce patient education on adverse effects to chemotherapy and the importance of reporting serious adverse effects. The APN also stressed the importance of completing the chemotherapy regimen as prescribed.
“The advanced practice nurse would do outbound calls to the patients to see how they were doing,” Moore explained. “They did not manage the patient, because that was up to the practice. Instead, they provided additional information and let the patient know that there was somebody else out there that they could come to with their questions.”
Patients could make as many inbound calls as they wanted, she added. “They were called once per cycle, but they could call into the call center every day, twice a day, five times a day if they needed some help or support. Some of it was psychosocial support, but most was about things like ‘I don’t feel well today and I don’t know what to do.’ The nurses would listen and give them general advice about what they could do to help themselves feel better, and then directed the women back to their physician and the nurse in the practice office.”
Pharmaceutical records were used to provide information on adherence in a group of patients undergoing similar IV chemotherapy without APN telephone support, who served as controls.
A total of 617 patients consecutively enrolled in the APN support program from January 2006 to March 2010.
Patients enrolled in the telephone support program completed nearly twice the number of chemotherapy cycles as the control patients. Patients in the intervention group completed nearly twice the number of cycles as control patients (3.8 vs 2 cycles). They also had fewer grade 3 to 4 adverse events. The rate of adverse events was 40% in the telephone intervention group and58% in the control group.
“This wasn’t a randomized, prospective, placebo-controlled trial, but it shows that there are other ways that nurses can support patients other than with a direct, hands-on approach,” Moore noted. “It also shows us that there is a role for telephone support for things other than oral adherence issues.”