CHICAGO–There are benefits to allowing patients with cancer to take oral cancer therapies at home instead of receiving infusions at the clinic, however it can place a self-management burden on patients – opening up the possibilities for poor adherence and poorer efficacy. Proper use requires a proficient understanding of the treatment.
In a randomized controlled trial of patients with cancer eligible to receive oral therapies, researchers tested whether a standardized patient education program conducted by oncology nurses could improve patient understanding of these agents and, by extension, adherence and potential side effects.
“Inadequate use of these drugs can lead to ineffectiveness and, in some cases, to early discontinuation of therapy,†first study author Manfred Welslau, MD, from the Hematological-Oncological Practice in Aschaffenburg, Germany, said during his discussion of the patient education program at the 2016 American Society of Clinical Oncology Annual Meeting.
Dr. Welslau and colleagues examined the effect of the education program in 178 patients (54% female; mean age = 70 years) from 28 office-based oncology practices in Germany.
Patients in the study had mostly solid tumor cancers, with 18 patients with myeloproliferative neoplasms and 10 with myeloid leukemia:
- Colon: 23 (intervention group) and 13 (control group)
- Myeloproliferative neoplasm: 14 and 4
- Breast: 14 and 4
- Lung: 10 and 5
- Brain: 10 and 2
- Plasmacytoma: 7 and 4
- Myeloid leukemia: 7 and 3
- Kidney: 5 and 2
- Prostate: 4 and 4
- Liver: 3 and 2
Other disease entities included malignant melanoma and stomach, pancreas, and uterine cancer (the patient numbers were not provided for these diseases).
“The results of the pre-study [to determine eligible oncology practices] showed a rather low prevalence of systematic concepts to promote the patients’’ competence in office-based oncology practices,†Dr. Welslau observed. “However, the oncologists are ready to support patient education by nurses with an oncology qualification.â€
All patients received the usual oncology counseling, but patients at 17 practices (the intervention group; n=122) received additional education (based on the MASCC Oral Agent Teaching Tool) from oncology nurses about their disease, treatment options, side effects, and proper handling of medication. Oncology nurses involved in the program were specifically trained on techniques of motivational communication and use of oral agents.
In the control group (n=55), patients received only counseling.
Patients in both groups were observed for three months to determine if providing patients with this additional information could improve performance on the following measures:
- self-management
- therapy-related knowledge
- medication adherence
Performance was measured by validated instruments that assessed self-efficacy, side effects, health-related stress, therapy-related knowledge, adherence, and quality of life.
Patients in the intervention group showed a higher level of therapy-related knowledge and a clearer understanding of behavior in critical situations compared with those in the control group. In addition, self-efficacy increased in the intervention group after the first counseling session, while the control group showed a slight decrease at this time point. The difference remained stable during the length of the study.
“Patients who went through [the program] are more competent than patients [in the control group] concerning therapy-related knowledge,†Dr. Welslau noted. “This knowledge enables patients to cope better with challenges and stress that arise from their cancer therapy.â€
Patients in the control cohort had more frequent side effects, such as skin rash, and they were more likely to interrupt therapy without informing their oncologist compared with the intervention group (25% vs. 14%).
“The study confirms the feasibility and effectiveness of a standardized patient education and supervision through oncology nurses in outpatient oncology care,†the authors concluded.
Reference
Welslau M, Riese C, Beylich A, et al. Patients’ competence in oral cancer therapies. Abstract #6517. Presented at the 2016 American Society of Clinical Oncology Annual Meeting, Chicago, IL, June 4, 2016.