Feasibility of a Nurse-Coordinated Intervention to Support Self-Management of Multiple Co-Occurring Cancer Symptoms

Background Symptom management guidelines are primarily written for single cancer symptoms despite patients experiencing multiple co-occurring symptoms. Coordinating recommendations across guidelines based on patients’ self-report of symptom clusters may facilitate efficient multisymptom self-management. Objective The aim of this study was to evaluate the feasibility of a nurse-coordinated approach to multisymptom management among patients receiving chemotherapy. Intervention/Methods Forty-one adults receiving cancer chemotherapy and experiencing ≥2 symptoms were recruited to this pilot randomized controlled trial. Participants self-reported symptom cluster experiences weekly, over 2 cycles of chemotherapy. All participants received usual care during the first cycle on study, and half were randomized to enhanced care during the second cycle. A nurse interventionist reviewed participants’ symptom cluster self-reports to understand symptom relationships and etiology, selected 1 or more guideline-based self-management strategies to treat multiple symptoms, and provided participants with weekly self-management instructions. Results Recruitment (85%) and retention (83%) met feasibility criteria. Nurse interventionists successfully coordinated a treatment plan with fewer self-management strategies than symptoms for 84% of participants’ symptom cluster reports. Coordination challenges included complex multisymptom etiology, prioritizing among self-management strategies, and symptoms with no guideline-recommended treatments. Most participants (≥72%) reported satisfaction with the intervention and study procedures. Conclusions Nurse coordination of management strategies for clustered symptoms is feasible and acceptable, and merits further intervention development. Implications for Practice Eliciting patients’ self-reports of symptom clusters provides important insights to drive management recommendations. Drawing on this knowledge and using evidence-based guidelines, oncology nurses may identify self-management strategies that are effective across multiple co-occurring symptoms to reduce patients’ symptom and self-management burden.