Improving Adherence to Oral Cancer Agents and Self Care of Symptoms Using an IVR

描述(申请人提供)：本申请的目标是提高癌症患者对口服化疗药物的依从性和症状的自我管理。目前市场上有40种口服药物，预计在3年内，25%的癌症治疗药物将以口服形式提供。因此，患者必须承担服药和相关副作用的自我管理的责任。为了解决这些问题，我们与四个NCI综合癌症中心合作，他们将根据患者的处方确定他们是口服药物，并提交研究，接受研究的人将被随机分配到两个手臂中的一个。所有患者都将接受每周8次的依从性和症状严重程度评估。此外，那些在试验组中的人将收到每天的提醒电话，要求他们在最初4周内根据自己的剂量量身定做剧本。对于报告的症状超过阈值，他们将被转介到症状管理指南(SMG)，以帮助自我管理。一个独特的功能是评估、提醒和症状管理策略将由交互式语音响应系统(IVR)提供。该系统已经在之前的试验和依从性的试点研究中进行了测试；它从患者那里获得了很高的满意度。测试了以下结果：在4周时，试验组将有更高水平的自我报告的依从性，症状管理和这些差异将在8周和12周保持。此外，试验组将在4周、8周和12周报告较低的依从率和依从率。探索性目的是评估患者和治疗变量对依从性和症状管理的调节作用。最终的探索性目标评估了一个重要但迄今未经检验的问题：依从性与患者症状管理之间的关系是什么？这项研究是由过去的试验和一项关于坚持口服药物和症状处理的大型先导性研究指导的。患者报告的依从性根据药片计数和患者记录中的脚本进行验证。每天的提醒包括一个问题，以确定剂量是否改变。如果发生这种情况，每个站点的工作人员都会监控来访和电话，以便在任何更改后立即停止提醒或调整剂量。所有管理症状的策略都是以证据为基础的，并通过该团队早期的工作进行了测试。达到紧急级别的症状会传达给每个站点的工作人员。这项试验通过一个项目网站进行协调。这项试验的影响是，它测试了一个简短的有针对性的提醒系统，以模拟治疗开始时的依从性。它伴随着以患者为中心的症状管理策略。该系统嵌入肿瘤学中心；它可能会改变口服化疗治疗，同时确保患者安全。

DESCRIPTION (provided by applicant): The goals of this application are to improve adherence to oral chemotherapeutic medications and self- management of symptoms among cancer patients. Forty oral agents currently are on the market with projections that in 3 years 25% of the cancer treatment agents will be delivered in oral form. As a result, patients must assume responsibility for taking medications and self-management of associated side effects. To address these issues we collaborate with four NCI Comprehensive Cancer Centers who will identify patients as they are prescribed oral agents, present the study, and those accepting will be randomized to one of two arms. All patients in both arms will receive 8 weekly assessments of adherence and symptom severity. In addition, those in the experimental arm will receive daily reminder calls for the initial 4 weeks of their scripts tailored to their dose. For symptoms reported above threshold they will be referred to a symptom management guide (SMG) to assist with self-management. A unique feature is that assessments, reminders, and symptom management strategies will be delivered by an Interactive Voice Response system (IVR). This system has been tested in a previous trial and in a pilot study of adherence; it received high satisfaction ratings from patients. The following outcomes are tested: at 4 weeks the experimental arm will have higher levels of self-reported adherence, and symptom management and these differences will be sustained at 8 and at 12 weeks. In addition, the experimental arm will report lower rates of both over and under adherence at 4, 8, and 12 weeks. Exploratory aims assess the moderating effects patient and treatment variables on adherence and symptom management. A final exploratory aim evaluates an important but heretofore untested question: what is the relationship between adherence and patients' symptom management? This research is guided by past trials and a large pilot study of adherence to oral agents and symptom management. Patient reported adherence is validated against pill counts, and scripts from patients' records. Daily reminders include a question to determine if dose was changed. If this occurs, staff in each site monitor visits and calls so that reminders are stopped or adjusted to dose immediately upon any alteration. All strategies for managing symptoms are evidence based and tested through earlier work of this team. Symptoms reaching urgent levels are communicated to staff at each site. This trial is coordinated through a project website. The impact of this trial is that it tests a short targeted reminder system to model adherence at the onset of treatment. It is accompanied by patient centered strategies for symptom management. This system is embedded into oncology centers; it can potentially transform oral chemotherapy treatment while assuring patient safety.