Helping Chemotherapy Patients Manage Pain and Fatigue Also Reduces Other Symptoms

WASHINGTON, DC—A nurse-directed intervention to help chemotherapy patients manage pain and fatigue not only relieved those symptoms but also reduced the number of other symptoms patients suffered, according to Barbara Given, PhD, RN, professor of nursing at Michigan State University in East Lansing. She reported results on behalf of researchers at that institution, as well as at the University of Michigan in Ann Arbor and Yale University in New Haven, Connecticut.

Results of this randomized, controlled clinical trial "support the need for targeted interventions to assist patients undergoing chemotherapy to manage pain and fatigue," Dr. Given concluded.

Varied Tumor Sites

The National Cancer Institute-funded study, which is now in its fifth year, included patients undergoing chemotherapy for breast, colon, lung, or other solid tumors who reported pain and fatigue at baseline. Patients entered the study within 56 days of their first chemotherapy cycle. Patients were randomized either to conventional care (n = 60) or to conventional care plus the nursing intervention (n = 53). The study endpoints were severity of pain and fatigue, limitations caused by pain and fatigue, and number of other symptoms reported at 20 weeks.

The nursing intervention was a 20-week, 10-contact program for patients and family caregivers. The program included problem solving approaches to symptom management, techniques for improving physical functioning, and strategies for maintaining emotional health. All of these areas were dealt with at each of the 10 contacts, and patients were interviewed about symptoms at baseline and again at 10, 20, and 32 weeks.

Key to applying nursing intervention was building it into the computerized documentation system. If pain and fatigue were present at "threshold levels," that fact was posted to the plan of care and had to be dealt with before the computerized record would advance to the next screen.

Symptom Clusters

Dr. Given explained that pain and fatigue are important not only in themselves but also because they are associated with other "symptom clusters." Patients who reported both pain and fatigue had a mean 6.3 additional symptoms, while those who reported neither pain nor fatigue had only 2.5 symptoms, according to data from this study presented at last year’s Oncology Nursing Society Congress.

At 20 weeks, patients randomized to the intervention group reported an average of four fewer symptoms than those in the conventional care group. Dr. Given said that 40 of the 53 patients in the intervention group vs 15 of the 60 patients in the conventional care group had clinically significant reductions in symptom scores, as measured by the Short Form 136 (SF136) health status questionnaire. Physical and social functioning also improved significantly in the intervention group, and all of these improvements occurred regardless of diagnosis and site of cancer.

"Physicians never believe the slides showing that site had no importance," Dr. Given commented. "These data show that behavioral interventions are beneficial and are beginning to show the value-added role of nursing for improvement of care."

Shorter interventions might also be effective. Dr. Given said that responses at the 10-week data collection point were so good that the researchers are now planning to compare a more intense 10-week program to the original 20-week intervention in a second randomized trial.