Evaluating the Feasibility of a Nurse-driven Follow-up Telephone Triage Intervention to Improve Post-treatment Outcomes in Head and Neck Cancer Patients Undergoing Chemotherapy and Radiation in the Ambulatory Setting

Head and neck cancers (HNCs) account for 3% to 5% of all cancers in the United States. HNC remains a considerable challenge to both patients, families and family caregivers, and healthcare providers because of persistent treatment related acute and long-term effects which interfere with the patients’ basic functions such as, breathing, tasting, chewing, swallowing, and speech. Most acute symptoms are experienced during the treatment and in first eight weeks after completion of chemotherapy and radiation. Since cancer treatment is increasingly delivered in outpatient settings, patients reporting treatment related symptoms by phone has become a growing trend. To date, studies demonstrate inconclusive data about the superiority of nursing telephone interventions compared to standard of care for symptom assessment in cancer patients. Studies suggest that patients feel best supported when providers are perceived to take an active interest in their symptom experience and offer advice and coaching to support symptom relief. Telephone triage programs are broadly described as a means for follow-up and monitoring the status of patients in surgical, medical, and oncologic settings. The use of proactive triage calls for symptom assessment are well-defined in the surgical oncology populations, but less so around patients undergoing anti-neoplastic therapies. Objective: The overall purpose of this pilot study was to explore the feasibility of a proactive nurse-driven telephone triage intervention and to evaluate whether pro-active follow-up calls during the post treatment period are beneficial to HNC patients with respect to the management of symptoms and patient satisfaction, and symptom experience of patients with HNC’s receiving chemoradiation therapy in the ambulatory setting. Methods: The study design is a single group (pre-post-test) quasi-experimental, repeated measures design that examines patient outcomes related to the use of nurse initiated weekly telephone follow-ups over 8 weeks. In this design, subjects served as their own controls. Sample /Setting: A convenience sample of 30 subjects, male and female, meeting eligibility requirements was recruited from head and neck medical and radiation oncology services at MD Anderson Cancer Center, Houston Texas. Results: Acceptable feasibility was defined as the completion of 70% of the nurse-driven calls. The actual completion of the calls was 92.19% [95% CI = 88.09, 94.95]. The best predictor of lower symptom management needs was the number of triage calls, after controlling for the age of the patients.