title: Nursing intervention to enhance outpatient chemotherapy symptom management: Patient-reported outcomes of a randomized controlled trial.
abstract: BACKGROUND
  The authors conducted a randomized controlled trial to evaluate a nurse practitioner (NP)-delivered symptom management intervention for patients initiating chemotherapy for nonmetastatic cancer. The aim was to reduce patient-reported symptom burden by facilitating patient-NP collaboration and the early management of symptoms.
  
  
  METHODS
  At the time of the first chemotherapy visit, adult participants with nonmetastatic breast, colorectal, or lung cancer (120 participants) completed self-report measures and were then randomly assigned to standard care plus the intervention or standard care alone. Intervention participants received proactive telephone calls from their oncology team NP during the week after each of the first 2 chemotherapy administration visits. Measures were repeated at the second and third chemotherapy visits. Group differences were analyzed with regard to patient-reported symptoms (Memorial Symptom Assessment Scale-Short Form items), satisfaction with care (Family Caregiver Satisfaction-patient scale), and the likelihood of depression or anxiety symptoms (Patient Health Questionnaire-4).
  
  
  RESULTS
  At the time of the first visit, 50.8% of participants reported ≥1 physical symptom, most commonly lack of energy (35.8%) and drowsiness (30.8%). The number of symptoms (gamma coefficient [γ] = 0.16; P<.001), symptom distress (γ = 0.45; P<.001), and satisfaction with care (γ = 0.24; P = .004) increased whereas the likelihood of anxiety symptoms decreased (γ = -0.19; P = .02) and the likelihood of depression symptoms did not change (γ = 0.01; P = .91). Outcomes did not differ by randomized group. Randomized group interacted with emetogenic potential in predicting symptom distress (γ = 0.43; P = .03) and satisfaction with care (γ = -0.45; P = .045).
  
  
  CONCLUSIONS
  The intervention did not appear to reduce symptom burden compared with standard care. Early symptoms highlight the importance of continuing to examine strategies to improve symptom management during chemotherapy for nonmetastatic disease.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lara
authors.initials: L
authors.lastname: Traeger
authors.affiliation: Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: McDonnell
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: McCarty
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.affiliation: Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: Hematology Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy; D015179:Colorectal Neoplasms / Q000188:drug therapy; D003863:Depression / Q000453:epidemiology; D019468:Disease Management; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology; D009859:Oncology Nursing; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D057566:Self Report; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: chemotherapy; health services intervention; nursing; oncology; patient-reported outcomes