Community Cancer Care, an Indianapolis-based provider of medical oncology services and cancer-related programming and Decatur County Memorial Hospital’s oncology partner, was recently awarded a grant from the National Institute of Health. The grant will fund a study to evaluate the impact of utilizing a nurse care manager in conjunction with home-based symptom monitoring to improve the management of cancer related pain and depression. Cancer patients receiving treatment at the Decatur Hospital oncology clinic will be eligible to enroll in this study. Known as the Telecare Management of Pain and Depression in Cancer Trial, the study is being conducted in partnership with the Regenstrief Institute for Health Care at the Indiana University School of Medicine in Indianapolis. 

“Cancer patients can experience many symptoms as a result of their cancer or their treatment. Pain and depression are especially prevalent and we need to understand how these symptoms are affecting their daily activities. Normally, symptoms are addressed during their next physician visit or chemotherapy appointment. Now, with this study, we can get more regular and timely feedback.  If a patient is in trouble we can intervene right away. We are very excited to participate in this study in conjunction with IU,” says Dale Theobald, PhD, MD, Quality of Life Program Director for Community Cancer Care. 

The Telecare Management of Pain and Depression in Cancer Trial is a randomized study. “This means that there are two groups of participants. One group will receive the normal ‘standard of care’ and the other will be assigned to participate in reporting their symptoms and working with our nurse care manager. All patients in both groups will be followed very closely,” says Dr. Theobald. 

For patients who are assigned to the group who report their symptoms, they can participate in one of two ways. A telephone component enables them to receive regularly scheduled phone calls at times they have pre-chosen. They can also make inbound calls themselves to a voice response unit (VRU) as often as they like. During these telephone calls, they are asked a series of questions about the symptoms they are experiencing due to cancer treatment and how these symptoms are interfering with their daily activities. Patients report the answers to these questions using the keypad on their touch-tone telephone. Results are sent immediately to the nurse care manager via fax. For patients who prefer to participate instead via their computer, they log onto a secure Internet site using a personal I.D. and password. 

Either way, a nurse care manager is assigned to the patients and will continually monitor their symptoms and act as a liaison to their cancer care team at the oncology clinic as well as be available to talk to patients via telephone. “Having the nurse care manager along with the symptom monitoring tool will enable us to run interference and act quickly when patients are having problems. Patients will be able to talk directly to the nurse care manager regarding their symptoms so there is always a two-way line of communication,” says Theobald. 

He adds that while there are many initiatives taking place in medicine that address and measure cancer’s symptoms, this study is unique because it is actually being implemented into routine care on a daily basis. “It’s great to participate in research pilot projects, but many times they stop there and don’t go any further. We want to capture valuable data that enable us to measure the feasibility and cost efficiency of utilizing this in clinics every day. This project will study the relationship between patients’ symptom burden and their quality of life. Eventually specific symptoms that accompany specific types of cancer will be known in order to build intervention roadmaps that healthcare professionals anywhere can use. That will allow cancer care teams to be proactive and intervene on an early basis. 

“This will also save patients and families distress and we hope to prove that it will save the healthcare system money in the long run. It may also translate to other diseases and be able to be utilized for other types of patients. A long-term goal of the project is to study the ability to assist patients before their symptoms escalate to a point that they need to make a trip to the emergency room and to determine whether utilization of a nurse care manager is effective and economically efficient,” adds Community Cancer Care’s Donna Butler, MSN, APRN BC, OCN and a member of Decatur County Memorial Hospital’s cancer care team. 

Cindy Daihl, RN, BSN, OCN, Oncology Manager, is excited with the possibilities this study will bring to cancer patients. “Our cancer patients have a lot of symptoms. We need a way to capture data about these and deal with them in a timely manner. It’s going to improve their cancer care immensely,” she says.