Pain and Symptoms of Cancer: Assessment and Treatment

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DESCRIPTION (provided by applicant): Cancer-related symptoms are often poorly treated even when effective symptom management is available. Based on previous work, this project will focus on a major barrier to good symptom management -- inadequate assessment. Reduction of symptoms is a major treatment goal for patients with advanced lung cancer. These patients have a poor prognosis and multiple symptoms such as pain, fatigue, and emotional distress. As more cancer therapy is done on an outpatient basis, patients go longer without symptom assessment. Minority patients are at greater risk for both poor symptom assessment and management. Frequent assessment using computer/telephone-based interactive voice response (IVR) systems may improve both the assessment and management process. The three objectives of the proposed research are: (1) Using the IVR system, to longitudinally assess the prevalence, severity, and interference caused by multiple symptoms in patients with advanced lung cancer, and to characterize factors, including minority and nonminority membership, that may lead to differences in symptom treatment and outcomes. This study will help identify the most distressing symptoms that these patients have, and when, in the course of the disease, they will be most severe. (2) Based on the longitudinal study, to develop symptom severity thresholds that indicate a need for provider notification, and to modify existing symptom management protocols to help providers respond quickly when notified that a patient is symptomatic. (3) To examine, in a randomized clinical trial, the effectiveness of combining IVR assessment, provider notification, and availability of guidelines in reducing symptom burden in advanced cancer, and to compare the effectiveness of this method between minority and non-minority patients.