Implementing a Toxicity Screening Form to Report Chemo Side Effects

The number of patients reporting side effects related to chemotherapy increased by more than 40 percentage points after the implementation of a chemotherapy toxicity screening form, according to results of a small single-center study.

According to the study, presented at the Oncology Nursing Society (ONS) 44th Annual Congress in Anaheim, California, by Jessica Hunter, MSN, RN, CMSRN, of IU Health Bedford Hospital in Bedford, Indiana, and colleagues, patients with cancer have been found to deny experiencing side effects when the nurse asks about toxicities in the treatment room, but report them later to the doctor in a private room.

In order to gain a more accurate idea of chemotherapy-related side effects, Hunter and colleagues developed a chemotherapy toxicity screening form to see if the form would increase patients’ likelihood of reporting side effects. The form was completed by the patient and then given to the nurse for review. A verbal discussion was initiated to discuss any noted effects.

“Our goal is not to eliminate verbal discussion of chemotherapy toxicities, but rather, we are attempting to protect patient privacy and increase symptom reporting by creating an alternate route of discussion for potentially embarrassing side effects,” Hunter and colleagues wrote.

In this study, the researchers audited all patient charts for 1 month prior to implementation of the side effect form and 1 month after. On the form, patients were asked to mark all symptoms they experienced in the last week, such as diarrhea, hair loss, rash, vomiting, and more, and a space for a fill-in-the-blank ‘other’ field. Patients were also asked if there was anything they wanted to discuss privately with the nurse or doctor.

Prior to the implementation of this form, 49% of patients reported chemotherapy-related side effects. After implementation that increased to 90% of patients.

Hunter and colleagues predicted an increase because they thought “patients are more likely to be honest and report potentially embarrassing side effects on paper rather than talking about them with other patients present.”

Because of the improved reporting of side effects seen in this study, Hunter and colleagues plan to continue using this toxicity screening form in the future.

Commenting on the study, Ian Olver, AM, MD, PhD, of the University of Adelaide in Australia, told Cancer Network, "It has been well described previously that providing patients with a list of side effects will elicit more side effects than open-ended questions or self report. Reasons for this range from some side effects being mild and not recalled, to some patients who are reluctant to report side effects because they believe that it may compromise their anticancer treatment if doses are reduced. This study suggests that it would be useful to prompt patients about side effects before they have a consultation with their oncologist."