Research Focuses on Helping Patients to Manage Oral Medications

With more and more cancer therapies being administered as oral agents, oncology nurses have a critical role to play in helping their patients to manage their medications and any side effects of treatment. Among the poster presentations at this year’s ONS Congress were several focused on how oncology nursing professionals can aid patients in adhering to their oral regimens, as well as encourage their patients to report any adverse events.

Toolkit Helps Patients Manage Oral Regimens

To improve adherence to oral chemotherapy treatment schedules, nurses at The Cancer Institute of New Jersey created a patient-friendly toolkit. Using evidence-based guidelines and gathering patient recommendations and feedback on the topic, they developed a screening technique to identify barriers to therapy adherence. When creating the toolkit, nurses added a color-coded pill diary with instructions, individualized calendars specific to a patient’s treatment regimen, and an education sheet about taking oral chemother-apy, which reviews safe handling procedures.

Proactive AE Management Optimizes Adherence

“Non-adherence to oral therapy has been shown to reduce treatment success, which could lead to additional doctor visits or even hospitalizations. By providing this set of easy-to-use tools, clinicians can help empower patients during each interaction,” noted lead author Yuk (Aggie) Wong, RN, BSN, OCN, MA. Wong, along with colleagues Pamela Scott, RN, OCN, and Heather Camisa, RN, BSN, OCN, plans to further evaluate the new toolkit via chart audits and patient/staff surveys. (Oncol Nurs Forum. 2013;40(3):e220)Patients with metastatic colorectal cancer (mCRC) taking the oral multikinase inhibitor regorafenib demonstrated a low discontinuation rate due to treatment-related adverse events (AEs), according to results of the phase III CORRECT clinical trial, suggesting that many AEs can be managed successfully to optimize treatment adherence.

Taline Khoukaz, MSN, ACNP-C, with the USC Norris Comprehensive Cancer Center, and Jessica Mitchell, RN, CNP, of the Mayo Clinic, looked at the potential for patient education and proactive symptom support measures to address some of the more common AEs experienced by mCRC patients being treated with regorafenib, among these, hand-foot skin reactions. They found that such skin reactions can be prevented or managed by implementing prophylactic strategies, including stringent patient monitoring, proactive supportive measures (eg, regular use of emollient creams, removal of calluses, and protection of tender areas and pressure points with thick gloves and socks), frequent clinic visits early on, plus AE patient education and reinforcement.

A Standardized Nursing Protocol for Oral Chemotherapy

Proactive interventions were analyzed for other AEs (hypertension, liver abnormalities, oral mucositis, diarrhea, and fatigue), with the investigators concluding that, “proactive AE management may improve the patient’s treatment experience and maximize patient adherence, allowing patients to continue their regorafenib therapy with minimal interference in their daily lives.” (Oncol Nurs Forum. 2013;40(3):e228)Researchers at Wayne State University and the Karmanos Cancer Center are developing a comprehensive, evidence-based Oral Chemotherapy Nursing Practice Protocol focused on patient education, symptom assessment/management with follow-up calls, and continuing adherence monitoring. Early data gathered from audits of retrospective clinic charts at the gastrointestinal oncology clinic where the protocol was pilot-tested, show that it has increased documentation of: patient education by 84.3%, follow-up calls and early symptom assessment by 67.7%, and adherence monitoring by 42.4%.

Heejin Kim, RN, MSN, OCN, and colleagues, noted that previous benchmarking data revealed “inconsistencies in nursing procedure, adherence monitoring, and documentation of care for patients receiving oral chemotherapy,” suggesting the need for a standardized protocol. They noted that their findings “provide evidence supporting utilization of nursing standards to improve care for patients receiving oral chemotherapy.” (Oncol Nurs Forum. 2013;40(3):e175)