A Nurse-Delivered Telephone Intervention to Impact Mucositis Symptom Severity and Prevent Dehydration in Lung and Head/Neck Cancer Patients Undergoing Chemoradiation: A Pilot Study

Abstract

The purpose of this descriptive pilot study was to determine if a nurse-delivered telephone intervention, tailored to the specific oral mucositis needs of the individual lung and head/neck cancer patient during chemoradiation, prevented dehydration. Uncontrolled symptoms from chemoradiation persist for cancer patients despite the use of current interventions to alleviate the side effects. Research has also shown that lung and head/neck cancer patients require special attention as cancer subtypes. A gap in intervention research to improve symptom management still exists within this population as evidenced by the data that demonstrate that lung and head/neck cancer patients are the number one visitors to emergency rooms and urgent cares facilities during treatment seeking relief for their uncontrolled symptoms. In order to improve symptom care within this population, a two-phase, qualitatively driven mixed-method design was conducted. Study participants were patients with lung and head/neck cancer undergoing their first line of treatment with concurrent chemoradiation therapy. Phase I of the study consisted of a descriptive study (n = 9) in which the participants received a tailored nurse-delivered symptom management intervention. The intervention consisted of supportive care education followed by proactive, tailored nurse coaching telephone calls delivered twice weekly. Nonparametric tests and descriptive statistics were performed on the data collected from the quantitative component (n = 9). A content analysis was conducted on qualitative guided interviews (n = 16) collected during phase II of the study, that not only investigated the feasibility of the intervention, but also identified any unmet symptom care needs of the chemoradiation patient. The research narrative merged the quantitative results into the core qualitative component for comprehensive analysis. Results indicated that the participants found the intervention feasible and acceptable; mucositis symptom severity was controlled, and dehydration avoided. Although not statistically significant over time, the intervention minimized mucositis and overall symptom severity, enabled symptom self-management, and improved perceived self-efficacy at various time points. The intervention group had no unscheduled medical visits for dehydration versus 40% rehydration rate in a proportional retrospective comparison group. This pilot study is the first known to prevent dehydration via nonautomated telephone counseling. Not only was there potential impact on health outcomes, but patients reported that the emotional support provided was crucial in helping them be successful in enduring their chemoradiation. This finding exemplifies significant differences of nurse-care from automated symptom management systems. Future research in a larger, more extensive study is needed to advance evidence-base practice for all types of cancer patients undergoing treatment.