Intervention Tests New Way to Coordinate Providing Symptom Management Strategies

Nurses are the cancer clinicians most likely to hear about patients’ symptoms and the ones frequently asked to provide evidence-based recommendations for managing these symptoms. Some symptoms have pharmacological treatments, for which prescribing clinicians can write scripts. But several interventions are behavioral strategies that patients can do on their own, sometimes with over-the-counter medications, lifestyle adjustments, or other actions (if you are a member of the Oncology Nursing Society, you can access their in-depth symptom resources).

A fundamental impediment to symptom management interventions is how difficult it is to ensure patients and caregivers have everything they need to manage their symptoms. To accomplish this, several steps are required. Patients must report their symptoms, clinicians need to review patient notes and provide recommendations, and follow-up assessments and management changes need to occur. Across all types of cancer clinics, this is rarely accomplished. The challenge is that symptoms often co-occur, whereas management strategies are typically directed at individual symptoms. Second, clinicians still lack routine assessment, coordination, or symptom management strategies.

A new intervention, developed and led by oncology nurses, aims to address these problems through a novel model of symptom management. The intervention requires patients to complete a comprehensive symptom assessment, after which a nurse reviews the results and coordinates a plan addressing multiple symptoms by identifying core symptoms and providing the fewest, most effective recommendations. For example, patients could report five symptoms all related to their cancer treatment, and the nurse would identify symptom management strategies effective across symptoms, particularly the symptoms the patients rate as the highest priority.

A new study tested this nurse-led co-occurring symptom management intervention. This study, led by Dr. Kris Kwenkkenboom, PhD, RN, FAAN at the University of Wisconsin and published in Cancer Nursing, showed that a nurse interventionist was able to identify symptom management strategies in 90% of patients. This was a small pilot study among 41 patients, and the next study will examine the efficacy of this intervention on patient outcomes. Patients reported that the nurse identified fewer strategies than the number of symptoms in each cluster (84%), that strategies were ranked by level of evidence (92%), and that they did not conflict with one another (92%). Only in about half (47%) of the reports could nurses identify a causal symptom, but almost always (92%) identified the relationships among symptoms. Some concerns were that many symptoms had not evidence-based management strategies, such as dizziness, mobility issues, or feeling shaky.

This model of symptom management is so exciting because it models a systematic and holistic view of patients’ cancer- and treatment-related symptoms. Managing one symptom at a time can be like a game of whack-a-mole: addressing one symptom may lead to the development of additional side effects. Having someone who looks across symptoms and provides recommendations, targeting causal symptoms, makes sense. More testing of this model, including how artificial intelligence can help coordinate data gathering and synthesis, can revolutionize symptom management and finally help ensure patients get the recommendations they need to maintain as high a quality of life as possible.