Automated Voice System Manages Chemo Symptoms

AMELIA ISLAND, Florida—Telephone calls from an automated voice system that refers patients to a specially prepared guide for help in managing their symptoms proved as effective as calls from nurse educators in helping cancer patients undergoing chemotherapy manage their chemotherapy-related symptoms, according to a randomized trial presented at the American Psychosocial Oncology Society (APOS) Third Annual Conference (abstract II-3).

The trial was led by Charles W. Given, PhD, Department of Family Practice, Michigan State University, East Lansing; funded through a grant from the NCI; and conducted in affiliation with the Walther Cancer Institute, Indianapolis. The researchers randomized 289 patients to receive cognitive behavioral interventions to help them cope with their chemotherapy symptoms over the telephone, delivered either by a trained cancer nurse (n = 144) or an automated voice intervention (AVI) system (n = 145). The patients had been screened for symptom severity at baseline, and all received six telephone calls over an 8-week period.

At each contact, patients were asked about the severity of 18 symptoms from the M.D. Anderson Symptom Inventory. Patients received intervention for any symptom that reached a score of 4 or higher in severity. These strategies were then evaluated in subsequent telephone contacts.

In the nurse arm of the study, the nurses assessed the 18 symptoms and organized strategies, including support and prescriptions for medication, and delivered cognitive information, restructuring, and behavioral techniques. They also referred patients to a Symptom Management Toolkit (SMT) for additional help.

In the AVI arm, the AVI prompted patients to answer questions about their symptoms. If any of their symptoms were rated above 4 in severity, the patients were referred to the SMT. All information on the strategies that were delivered, those that were tried, and those that were implemented successfully were collected in real time by computer software.

Overall, both arms were equally effective in lowering symptom severity, Dr. Given reported. There were no effects for age, gender, or stage of cancer. The AVI system appears to be as effective in lowering chemotherapy-related symptoms as does a more complex intervention delivered by nurses, he concluded. Moreover, patients appear to be equally satisfied with both methods. "The satisfaction rates are virtually identical," Dr. Given said. "Many patients said they would have liked to have had a person talk to them, but confessed they were very happy to have their symptoms monitored and to be directed to a symptom management tool kit. And, of course, they knew that any urgent symptoms would be reported to their oncology practice."