Improving Adherence to Cancer Treatment by Addressing Quality of Life in Patients With Advanced Gastrointestinal Cancers

J Pain Symptom Manage. 2015 Sep;50(3):321-7. doi: 10.1016/j.jpainsymman.2015.03.005. Epub 2015 May 12.

Abstract

Context: Many patients with potentially curable cancer do not complete their prescribed treatment regimens because of the toxicity. There is evidence that the common endpoints of many of these toxicities are amenable to quality of life (QOL)-directed interventions.

Objectives: This study was conducted to determine the effect of a multidisciplinary QOL-directed intervention on patients' adherence to planned chemoradiation (CR) regimens.

Methods: The results of two randomized controlled trials that used the same QOL intervention were pooled to form a cohort of 61 patients with advanced localized gastrointestinal cancer. Of these 61 subjects, 29 participated in six to eight bi- to triweekly sessions that included exercise, education, and relaxation, and 32 received usual medical care. The primary endpoint was completion of their prescribed CR regimens. Secondary outcomes included hospitalization during CR, rates of adverse postoperative events, and complete pathological response in those undergoing neoadjuvant therapy.

Results: Significantly, more members of the intervention than the control group completed their planned CR regimens (77.8 vs. 38.2%, P = 0.003). More participants in the control (n = 14) than the intervention (n = 5) group (P = 0.063) required hospitalization. Among those undergoing neoadjuvant CR, those in the intervention group were significantly more likely to complete CR as planned (81.0% vs. 37.5%, P = 0.005) and less likely to be hospitalized (14.3% vs. 50.0%, P = 0.011).

Conclusion: A structured multidisciplinary QOL-directed intervention delivered to patients undergoing CR may increase the proportion of patients who complete CR as planned and reduce unplanned hospitalizations. Utilization is an important outcome in QOL-directed intervention trials.

Keywords: Chemoradiation; hospitalization; neoadjuvant; prehabilitation; treatment tolerance.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chemoradiotherapy / methods*
  • Chemoradiotherapy / psychology*
  • Chemoradiotherapy / statistics & numerical data
  • Exercise Therapy / methods
  • Exercise Therapy / psychology
  • Exercise Therapy / statistics & numerical data
  • Female
  • Gastrointestinal Neoplasms / epidemiology
  • Gastrointestinal Neoplasms / psychology*
  • Gastrointestinal Neoplasms / therapy*
  • Hospitalization / statistics & numerical data
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Patient Education as Topic / methods
  • Patient Education as Topic / statistics & numerical data
  • Quality of Life / psychology*
  • Relaxation Therapy / methods
  • Relaxation Therapy / psychology
  • Relaxation Therapy / statistics & numerical data
  • Treatment Outcome