adherence, symptoms, intervention, chemotherapy, oral agent


Medicine and Health Sciences


Background: The use of oral chemotherapy agents to treat cancer has increased. Patients are responsible for adhering to complex dosing regimens, while monitoring and managing symptoms from side effects of the chemotherapy at home.

Objective: This study examined an intervention to manage symptoms and promote adherence to oral chemotherapy agents.

Intervention and Methods: A 3 group exploratory pilot study determined how an Automated Voice Response (AVR) system alone (N=40), or the AVR with strategies to manage symptoms and adherence (N=40), or the AVR with strategies to manage adherence (N=39) reduced symptom severity and improved adherence. Participants received a Symptom Management Toolkit, completed a baseline interview, and were randomized to receive 8 weekly AVR calls. The AVR directed patients to the toolkit for high symptoms and nurse calls occurred for management of severe symptoms or non-adherence. An exit interview occurred at 10 weeks.

Results: Mean age was 59.6, with 70% female and 76% Caucasian. Overall, 42% of patients were non-adherent, with missed doses increasing with regimen complexity. Symptom severity declined over time in all groups. No difference was found in adherence rates among intervention groups. Higher adherence rates were related with lower levels of symptom severity across groups.

Conclusions: Adherence is a significant clinical problem, which can affect efficacy of the cancer treatment. The AVR intervention alone was just as effective as the AVR plus the nurse intervention at promoting adherence and managing symptoms from side effects.

Implications for Practice: Nurses need to focus on patient education by assuring patient understanding of oral agent regimen, and the need to adhere to the oral agent for efficacious cancer treatment. Nurses can promote the use of medication reminders and self- management of symptoms from side effects, to support adherence to the oral agent.


Original Citation:

Spoelstra, S. L., Given, B. A., Given, C. W., Grant, M., Sikorskii, A., You, M., & Decker, V. (2013). An Intervention to Improve Adherence and Management of Symptoms for Patients Prescribed Oral Chemotherapy Agents: An Exploratory Study. Cancer Nursing, 36(1), 18–28.