1. Symptom Attribution of Older Cancer Patients with Comorbid Conditions during Chemotherapy Treatment
S. Spoelstra, PhD, RN1; B. Given, PhD, RN, FAAN1; M. Schueller, BA1; K. Ridenour, Nurse Scholar1; M. Hilton, RN1; and C. W. Given, PhD2
1 College of Nursing; 2 Family Medicine, at Michigan State University, East Lansing, MI
Background
60% of cancer patients are elderly.
75% have comorbid conditions.
Having comorbid conditions in addition to
cancer may exacerbate symptom severity.
15% of cancer treatment is in pill form
Expected to increase to 25% in 3-years.
Some patients with symptoms:
adjust,
interrupt, or
stop dosages of cancer pills compromising the cancer treatment.
Methods
Design: 5 phone interviews over 8-weeks
Weeks: 1, 2, 3, 4, & 8
Inclusion: With 30-adult cancer patients
prescribed oral chemotherapy agent
Recruitment: from 6-centers.
Data Collection: cancer site, cancer stage, treatment, comorbidities, symptom severity, and attribution.
Data Analysis: Generalized Estimating
Equations with compound symmetry
covariance structure to examine
associations between attributions & factors.
Characteristics
N=30
Mean Age (years) 65
Gender
Female (N)
50% (15)
Male (N)
Race
Caucasian (N)
83% (25)
African American (N)
17% (5)
Mean # Comorbidities (SD)
2.0 (1.7)
Mean # Symptoms (SD)
Range 0—15
5.3 (2.8)
Results
No evidence was found that attribution was associated with race, gender, age, cancer stage or type; nor was there change over time.
Models that included attribution to comorbid conditions were more likely in older, female, African Americans.
Minimal symptom change was found over the 5-interviews in those with or without comorbid conditions.
Purpose
To describe the attribution of symptoms* to the cancer, cancer treatment, or comorbid conditions in patients undergoing treatment with oral agents; and
To describe if those with comorbid conditions have more severe symptoms.
* fatigue, pain, numbness or tingling, sleep disturbance,
diarrhea, distress, swelling in hands or feet, lack of appetite,
constipation, shortness of breath, redness or swelling or
pain in hands or feet, constipation, skin rash or sore, sores
in mouth, or fever
Implications
One-third of patients associated symptoms with comorbid conditions in addition to their cancer and treatment.
Clinicians caring for cancer patients undergoing oral treatment need to consider how patients attribute symptoms; and if what is making them sick is what they focus on an attempt to control through self-management.
Framework
A synthesized model from the:
Health Belief Model,
Theory of Reasoned Action, and
Social Cognitive Theory guided this study
guided selection of factors examined in this study.
Attribution
N=30
Cancer & Treatment (N)
57% (16)
Comorbidities & Cancer & Treatment (N)
36% (11)
Comorbidities Alone (N)
7% (3)
This research was supported by a grant entitled: 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; from the Walther Cancer Foundation, Indianapolis, IN