Feasibility of Patient Controlled Nondrug Therapy for Pain and Symptom Management in Patients with Cancer

Kristine Kwekkeboom, PhD, RN

Patients undergoing treatment for advanced cancer frequently experience symptoms such as pain, fatigue, and sleep disturbance that co-exist or "cluster" within patients.  Practice guidelines and research evidence for the individual symptoms suggest that nondrug (cognitive-behavioral) strategies may be effective treatment with few, if any, side effects.  Given the interaction among pain, fatigue, and sleep disturbance, a nondrug strategy that is effective for one symptom may also have beneficial effects on the others.  For example, controlling pain may permit better sleep and subsequently reduce fatigue.  Nondrug strategies, however, are not equally effective for all patients, and training in just one strategy may not be sufficient.  Providing multiple nondrug strategies is complicated by the fact that oncology nurses often do not have sufficient time and equipment to administer the interventions in practice.  A patient-centered approach to symptom management would allow individuals to select from a variety of nondrug strategies based on their personal preferences, skills, and interests and would permit their use at whatever time and place the symptoms occur.  The purpose of this study is to assess the feasibility of a patient-controlled nondrug therapy (PCNT) intervention, using an MP3 player to deliver multiple recorded nondrug strategies for cancer-related pain, fatigue, and sleep disturbance during treatment.  Specific aims are (1) to assess feasibility of the PCNT intervention in patients receiving treatment for advanced cancer, (2) to evaluate participants' perceptions of the PCNT intervention including changes in symptom intensity, and (3) to determine if patients receiving a particular form of treatment (chemotherapy or radiotherapy) are more amenable to treatment with the PCNT intervention.  Using a one group, pretest-posttest design, 30 patients receiving cancer treatment (15 chemotherapy, 15 radiotherapy) will be taught to use the MP3 player and keep a daily diary over a 2-week period.  Outcomes to be measured include symptom intensity ratings, perceived control over symptoms, and an evaluation of the PCNT intervention.  Data from this feasibility study will be used to support an R21 application for further development and testing of the PCNT intervention.  This line of work will advance our knowledge of the effects on nondrug interventions on co-existing symptoms and could significantly reduce symptom distress and patient suffering without increasing burden on nursing staff.