Systematic Nurse Involvement Key as Oral Chemotherapy Use Grows

A survey-based study out of Japan has revealed that more systematic approaches to nursing practices will be required to ensure ongoing patient safety and adherence as it relates to oral chemotherapy.

According to the study by Hiroko Komatsu, PhD, RN, of Keio University, Tokyo, and colleagues, nurses must continue to play a significant role in the education and monitoring of those patients with cancer assigned to oral chemotherapy.

“As a growing number of patients are choosing oral chemotherapy over intravenous administration, the issue of adherence is becoming increasingly important in oncology,” the researchers wrote in BMS Research Notes. “The primary roles of oncology nurses in patients on oral chemotherapy include patient education, communication, symptom management, and proactive follow-up.”

In order to determine a baseline level of nursing practices surrounding oral chemotherapy, Komatsu and colleagues mailed two self-reported surveys on nursing practices for oral chemotherapy to 309 designated cancer centers and 141 large hospitals in Japan. The surveys were designed to identify any potential issues and to develop methods to improve medication adherence.

The first survey was a nurse-based questionnaire that contained 40 questions on nurse’s characteristics, staffing, and general nursing care for patients on oral chemotherapy, including both those new to the treatment and those with refilled prescriptions. The second survey focused on patients and contained 10 items on their characteristics and adherence-related nursing practices. Sixty-two hospitals and 62 nurses participated in the survey about 249 patients on oral chemotherapy.

Survey results indicated that 90% of nurses reported asking patients on oral chemotherapy about emergency contacts, side effects, and family/friend support. Nurses also provided patients with education materials on their assigned medication. However, less than one-third of nurses asked if their patients felt confident about managing their oral chemotherapy.

“Nurses were less likely to ask adherence-related questions of patients with refilled prescriptions than of new patients,” the researchers wrote. “Regarding unused doses of anticancer agents, 35.5% of nurses reported that they did not confirm the number of unused doses when patients had refilled prescriptions.”

The nurse-based survey revealed that systematic approaches to management were lacking:

• 40.3% of nurses provided oral chemotherapy orientation.

• 32.3% of hospitals offered interdisciplinary learning on oral chemotherapy.

• 43.5% of hospitals had a system-based approach for detecting prescription errors for oral anticancer agents.

Results of the patient-based survey showed that the nurse asking questions on side effects, having discussions about barriers to achieving balance between treatment and daily life activities, and medication management were all significantly related to whether the nurse initially asked the patient about unused medications.

“With the increase of oral chemotherapy, a new model of patient care is required,” the researchers wrote. “A more systematic approach should be developed to ensure patients received safe and effective oral chemotherapy, while nurses should play significant roles in patient education and monitoring.”