Telephone Support Increases Adherence to IV Chemotherapy for Recurrent Ovarian Cancer

Women who are on intravenous (IV) chemotherapy regimens for recurrent ovarian carcinoma are at risk for nonadherence or nonpersistence with their treatment. But telephone support by an advance practice nurse (APN) can lower this risk and even boost compliance, a new, nonrandomized study suggests.

 

“Nonadherence is not just an issue with oral chemotherapy,” said Susan Moore, RN, MSN, ANP, AOCN, of MCG Oncology, Chicago, Illinois, at her poster presentation during the Oncology Nursing Society’s 2010 Advanced Practice Nursing /Institutes of Learning Conference in Orlando, Florida. “Patients who are on IV regimens can also be nonadherent with their treatment. We think they are adherent because they show up, but often they are nonpersistent, meaning that they stop before the end of a planned regimen. Telephone support is just another way for APNs to do their outreach to patients.”

 

APNs are challenged to develop programs that support patient adherence and persistence to prescribed cancer therapies, especially therapies for advanced disease. Ovarian cancer is a particularly difficult cancer to treat, Moore noted.

 

“Patients who are on liposomal doxorubicin may not be completing their full six cycles. Many drop out because of side effects that are not well managed,” she said. “Sometimes patients are afraid or embarrassed to call their nurse or their doctor to tell them they want to quit. Instead, they just don’t come back.”

 

This study evaluated the efficacy of an APN-staffed telephone patient-support program in increasing adherence to IV chemotherapy in this setting. Participants in the program received a telephone call from an oncology APN before and after each chemotherapy infusion for up to six cycles to reinforce patient education on adverse effects to chemotherapy and the importance of reporting serious adverse effects. The APN also stressed the importance of completing the chemotherapy regimen as prescribed.

 

Patients could make as many inbound calls as they wanted. “The nurses would listen and give them general advice about what they could do to help themselves feel better, and then directed the women back to their physician and the nurse in the practice office.”

 

Pharmaceutical records were used to provide information on adherence in a group of patients undergoing similar IV chemotherapy without APN telephone support, who served as controls.

 

A total of 617 patients consecutively enrolled in the APN support program from January 2006 to March 2010.

 

Patients enrolled in the telephone support program completed nearly twice the number of cycles as control patients (3.8 vs 2 cycles). They also had fewer grade 3 to 4 adverse events. The rate of adverse events was 40% in the telephone intervention group and58% in the control group.

 

The study shows us that “there is a role for telephone support for things other than oral adherence issues,” Moore said.