title: Treatment with oral anticancer agents: symptom severity and attribution, and interference with comorbidity management.
abstract: OBJECTIVE
  To evaluate the prevalence, severity, and attribution of symptoms, as well as the interference with management of comorbidities, in patients who have been prescribed oral anticancer agents (OAs).
  
  
  METHODS
  Descriptive exploratory study.
  
  
  METHODS
  A comprehensive cancer center and two community-based oncology programs in the midwestern United States.
  
  
  METHODS
  30 adults undergoing OA treatment.
  
  
  METHODS
  Five phone interviews were conducted during eight weeks. Linear mixed effects and generalized estimating equations were used to examine symptoms and interference over time.
  
  
  METHODS
  Symptoms and comorbid conditions.
  
  
  RESULTS
  The mean age of participants was 65.1 years. Fifteen participants were female, 25 were Caucasian, and 23 had comorbidities. Twenty-one patients had late-stage cancer, and rates of adherence were 90%. Fatigue, sleep disturbance, and numbness or tingling in hands and feet were highly prevalent symptoms. Younger age was associated with higher symptom severity (p < 0.01) and interference (p = 0.01). Patients with more comorbidities tended to report higher symptom severity. Simultaneous IV chemotherapy was not a predictor of symptom severity or interference over age and comorbidity. Symptoms were most frequently attributed to cancer and its treatment. Patients with a greater number of comorbidities were more likely to include comorbidities in symptom attribution and reported interference from the OA with managing comorbid conditions.
  
  
  CONCLUSIONS
  Symptoms may be more severe in patients prescribed OAs who are younger and have comorbid conditions. More comorbidities and absence of simultaneous IV chemotherapy increased the likelihood of inclusion of chronic conditions in symptom attribution. Patients reported that OA treatment interfered with comorbidity management.
  
  
  CONCLUSIONS
  Nurses need to take comorbidities into account when caring for patients prescribed OAs because the chronic conditions may influence symptom severity and the ability to manage symptoms.
authors.affiliation: College of Nursing, Michigan State University in East Lansing.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Spoelstra
authors.affiliation: Department of Family Medicine, Michigan State University in East Lansing.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Given
authors.affiliation: Department of Statistics and Probability, Michigan State University in East Lansing.
authors.forename: Alla
authors.initials: A
authors.lastname: Sikorskii
authors.affiliation: Department of Statistics and Probability, Michigan State University in East Lansing.
authors.forename: Atreyee
authors.initials: A
authors.lastname: Majumder
authors.affiliation: College of Nursing, Michigan State University in East Lansing.
authors.forename: Monica
authors.initials: M
authors.lastname: Schueller
authors.affiliation: College of Nursing, Michigan State University in East Lansing.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Given
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D063189:Symptom Assessment
chemical_list: D000970:Antineoplastic Agents
keywords: age; attribution; cancer; comorbid condition; intervention; oncology; oral agent; oral anticancer agent; strategies; symptom severity