Effect of a structured chemotherapy-education-intervention versus standard-of-care on knowledge and self-care among cancer patients at Moi Teaching and Referral Hospital

Abstract

Background: Cancer is the 3rd leading cause of mortality in Kenya. The increasing prevalence of cancer has necessitated administration of chemotherapy in an outpatient setting. Therefore, any debilitating and distressing chemotherapy side-effects are experienced by patients at home. Self-care refers to patients‘ ability to self-observe, recognize and label symptoms, judge their severity, undertake treatment options and evaluate the effectiveness of the intervention undertaken. This study set out to determine whether a well-structured and standardized chemotherapy-education-intervention will further improve knowledge on chemotherapy side-effects and self-care compared to a non-standardized standard-of-care. Objective: To determine the effect of standardized-chemotherapy-education compared with the standard-of-care on patients‘ knowledge and self-care on chemotherapy side effects among ambulatory cancer patients Methods: This was an open-label randomized controlled study conducted at the ambulatory cancer unit of Moi Teaching and Referral Hospital (MTRH). The study recruited 366 newly diagnosed solid cancer patients who were equally distributed between the intervention and control arms. The intervention arm received a standardized chemotherapy-education which followed the National Comprehensive Cancer Network (NCCN) guidelines with supportive written material and weekly follow-up phone calls while the control arm received unstructured and non-standardized clinician-centered education. Socio-demographic data and clinical characteristics of the participants were collected using an interviewer-administered questionnaire. Participants were subjected to a pre-piloted interviewer-administered questionnaire before receiving 1st chemotherapy treatment (T1) and before the 2nd chemotherapy treatment (T2), 1-4 weeks apart. They were asked to provide information on their knowledge of chemotherapy side effects and self-care behavior taken to alleviate the side-effects. Data were analyzed using STATA version 16. Knowledge score was summarized using means and their corresponding standard deviations. Difference-in-difference test was used to compare the knowledge gained between the two arms of treatment between T1 and T2. Proportion of correct actions taken was summated as a percentage score. The scores were summarized as medians and their corresponding interquartile ranges. Wilcoxon rank-sum test was used to assess the differences in proportion of correct action taken between the two arms of treatment. Results: There was a significant increase in knowledge from baseline for the intervention arm (T1 mean score 5.034; T2 mean score 9.743) compared to the control arm (T1 mean score 5.429; T2 mean score 8.611) with a difference-in-difference analysis mean score of 1.527 (95% CI: 0.963-2.091; p<0.001). The intervention group was able to take 42.9% correct self-care actions to alleviate symptoms compared to control group who managed 33.3%. The difference between the two median scores was statistically significant -4.850 (p=0.001). Conclusion: A well-structured and standardized chemotherapy-intervention-education program improves chemotherapy side-effects knowledge and implementation of self-care behaviours among ambulatory cancer patients undergoing chemotherapy treatment compared to an unstructured standard-of-care clinician-centered education. Recommendations: A well-structured and standardized educational package should routinely be in use for ambulatory chemotherapy-naïve patients scheduled for chemotherapy treatment. Future prospective studies to assess cumulative gain in knowledge and self-care throughout full course of chemotherapy treatment should be done.