Determining Preferences for Symptom Management Assistance For Those with Oral Anti-Cancer Treatment Sandra L. Spoelstra, PhD, RN GSA Annual Meeting New Orleans, LA November 22nd, 2013

Project Team Sandra L. Spoelstra, PhD, RN (PI) Assistant Professor Michigan State University College of Nursing Charles W. Given, PhD (Co-PI) Professor, Michigan State University College of Human Medicine, Department of Family Medicine Barbara A. Given, PhD, RN, FAAN (Co-PI) University Distinguished Professor and Associate Dean of Research Michigan State University College of Nursing Alla Sikorskii, PhD Statistician, Michigan State University Department of Probability and Statistics

Funding Source Grant Award: Walther Foundation, Indianapolis IN Project Title: Determining severity, interference, and number of days of symptoms from side effects in cancer patients prescribed oral chemotherapy agents, how comorbid conditions may influence symptoms, and patient actions and preferences in regard to symptom management.

Objectives for Presentation 1)To understand patient preference for help with symptom management from side effects of treatment. 2)To understand the need for clinicians to tailor assistance for symptom management to the preference of patients.

Background & Significance Nearly 50 oral anti-cancer agents are on the market, and it is projected that in 3 years, 25% of chemotherapy will be delivered in pill form. Patients are responsible for managing symptoms at home and interact less often with clinicians.

Aim of Study To conduct in-depth phone interviews with patients undergoing treatment with oral anti-cancer agents to better understand preference for obtaining symptom management information.

The Present Study Descriptive cohort study Mixed Method (Quantitative & Qualitative) N=30 Over 8 weeks Including 5 assessments –Baseline (week 1) –Weekly (week 2, 3, 4) –Exit (week 8)

Sample & Setting 3 Community Cancer Centers In the Midwest Minimum Age 21 Any type or stage of cancer Non-hormonal anti-cancer agents In 2013

Age Mean: 65 Range: N=19 (64%) >60 years Gender N (%) Female15 (50) Male15 (50) Race Caucasian25 (83) African American 5 (17) Comorbid Conditions None 7 (22) (44) 3+10 (34) Symptom Mean: 5.1 to 5.6 (Assessment 1-5; Range 0-10) Summed Symptom Severity Score = 25.3 decreased to 22.3 (Assessment 1-5; Range 0-150) (not significant; paired t-test, t = 0.98, p = ). Only 2 of 148 patients calls had “No” symptoms

SymptomsN (%) Fatigue25 (83) Pain25 (83) Numbness/tingling19 (63) Sleep disturbance16 (53) Diarrhea12 (40) Distress 11 (37) Swelling of hands/feet11 (37) Lack of appetite10 (33) Shortness of breath10 (33) Redness and/or swelling in hands or feet 9 (30) Pain in hands and/or feet9 (30) Constipation7 (23) Skin rash/skin sores6 (21) Nausea/vomiting6 (21) Sores in mouth5 (17) Temperature >1011 (3)

Cancer Type N (%) Colon10 (30) Leukemia 4 (13) Breast 3 (10) Ovarian 2 ( 7) Myeloma 2 ( 7) Rectal 2 ( 7) Pancreatic 2 ( 7) Bone 1 ( 3) Fallopian Tube 1 ( 3) Kidney 1 ( 3) Stomach 1 ( 3) Scalp 1 ( 3) Neoplasm 1 ( 3)

Oral AgentsN (%) Xeloda16 (53) Revlimid 3 (10) Etopside 3 (10) Gleevec 2 ( 7) Hydrea 2 ( 7) Tykerb 2 ( 7) Everolimus 1 ( 3) Chloromeicil 1 ( 3) Xeloda & Tykerb 1 ( 3) Type of Regimen Complex20 (67) Simple10 (33) Dose Decreases10 (33) IV Chemotherapy13 (43) N=3

What is the preferred mode for symptom management information? 37% (N=11) Phone –30% Land-line –7% Cell phone 27% (N=8) Written material 23% (N=7) 10% (N=3) Face-to-Face 3% (N=1) Text message

 No difference in preference by age, gender, race, type of cancer, oral agent or other treatment (IV chemo and radiation).  Later stage cancer preferred written material (p=.03).  There was a marginal association (p=0.08) in preference for those with comorbid conditions for phone calls or .  Patients reported in qualitative questioning that they preferred to have written information in addition to the face-to-face or phone conversations they had with clinicians, so that they could refer back to the information as needed.

Implications for Practice Preference for assistance is via phone call or written material, with few desiring or face- to-face interactions. Those with later stage lung cancer preferred written material, however, the N was so small it needs to be replicated. Those with comorbid conditions, which may be a proxy for more self-management burden, may prefer or phone calls.

Implications for Research Interventions need to be tested on the effectiveness of written symptom management tools to supplement verbal (phone or face-to-face) interactions for those on oral agents with sever symptoms.

Conclusion In the fast paced clinical setting communication (phone or face-to-face) with patients is often verbal. In addition to verbal communication, clinicians need to provide “written information” on symptom management strategies to patients if desired.