Abstract
The aim of this study was to investigate the feasibility and acceptability of a repeated measurement of 5 major side effects (pain, nausea, vomiting, anxiety, and fatigue) experienced by patients during an entire course of chemotherapy. Forty-nine inpatients receiving intravenous chemotherapy in the medical oncology department of the Institut Paoli-Calmettes (Marseilles, France) were included in the study. At the study entry and every 12 hours from beginning of chemotherapy course, nurses assessed symptoms using Visual Analogic Scales (except for vomiting measured in number of episodes). Patients' pretreatment characteristics and their degree of satisfaction with nursing assessment were also recorded. The mean number of symptom measures was 2.9 in courses of less than 3 days, 5.4 in courses of 3 days, and 7.5 in courses of more than 3 days. Symptom patterns varied according to length of course. Furthermore, patients' pretreatment characteristics (age, sex, marital status, education level, type of cancer) had an impact on symptom scores at baseline and during treatment. About 80% of patients judged the nursing assessment as not constraining and 55% considered that its impact on their care was positive. This study demonstrates that repeated measurement of chemotherapy side effects was feasible and provide useful information for symptom management that might increase patient treatment satisfaction.
Anticancer treatments, particularly the majority of chemotherapy protocols, induce numerous side effects. For a long time, their impact on patients' well-being was estimated through clinical reports of toxicity using World Health Organization (WHO) and National Cancer Institute (NCI) criteria. Now, investigators concentrate on the patient as a source of information on treatment toxicity. Some of our previous studies have shown that side effects of treatment were more frequent and distressing for patients than generally recognized, and, in addition, there was a strong physician-patient discrepancy in the measurement of these side effects. 1-3 This discordance in evaluating treatment side effects, also found by other investigators, 4-10 poses varied problems but mainly for quality of care. Certain studies have explored whether this discordance was also observed with proxy or nursing assessment. 5,11-16
It is recognized that anticancer treatment side effects, notably chemotherapy toxicity, dramatically deteriorate patients' quality of life. Despite their relatively slow development, quality-of-life studies measuring the impact of treatments in oncology have significantly increased in the last decade. These have provided pertinent arguments for medical decision making in numerous situations 17-21 but remain mainly confined to clinical trials. In addition, it is recognized that findings of clinical trials are not incorporated into clinical practice. 22 They do not, therefore, allow individual supportive care or immediate medical symptomatic treatment to control symptom.
Problems 23 encountered by oncologists (difficulty to use quality-of-life questionnaires in clinical practice, provision of quality-of-life information in a format that is not always easy to understand or interpret from a clinical point of view) combined with underestimation of treatment side effects results in a minimal evolution in patient daily care. Only a few investigators 24-29 have shown an interest in quality-of-life measures to improve patient comfort. In a survey of 60 oncologists, published in 1996, 30 only 7% of respondents evaluated quality of life of their patients with a structured methodology. Yet, Detmar and Aaronson 31 showed that to introduce routine individual quality-of-life measures was feasible, and encouraged physicians to do so.
We investigated both the feasibility and acceptability of a repeated assessment by nurses of 5 major side effects experienced by patients during an entire course of chemotherapy. Since we hoped that this repeated evaluation would result in an improved patient-nurse relationship (because of a greater proximity) and in better daily care, we also explored patient satisfaction. The nursing assessment was conducted in an inpatient setting. We hypothesized that nurses would perform better than physicians in assessing the patient experience of chemotherapy with the aim of improving symptom management. This evaluation performed by nurses using the technique of the Visual Analogic Scale (VAS) was first proposed to patients receiving chemotherapy in a medical oncology department. Here, we report the results of the nurses' symptom assessment as a proxy for their patients and the impact of this evaluation on patient satisfaction.