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2015 HSR&D/QUERI National Conference Abstract

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1028 — Cancer CarePartners: Can Family Caregivers Help Veterans Undergoing Chemotherapy Manage their Symptoms?

Silveira MJ, AAVAMC CCMR; Sikorskii A, Michigan State University; Given C, Michigan State University; Piette JP, AAVAMC CCMR;

Objectives:
"Cancer CarePartners" (CCP) is a Web-enabled program designed to help caregivers of Veterans undergoing chemotherapy track symptoms and receive structured advice for how to help the Veteran. CCP includes weekly, automated telephonic symptom assessment with self-management support to the Veteran paired with Web-based symptom alerts to the caregiver pointing them to a website where s/he can obtain customized advice for symptom management. We conducted an RCT of CCP: 1) To determine if Veterans undergoing chemotherapy who receive CCP report significant improvement in the severity of symptoms (the sum of 0-10 severity across 8 core symptoms) compared to Veterans receiving an attention control; secondarily, to determine if they experience better adherence to chemotherapy and utilization of healthcare. (2) To determine if caregivers participating in the intervention provide significantly more social support to Veterans than do controls; secondarily, to determine if they experience more caregiver burden and distress than do controls.

Methods:
Consenting Veterans with solid tumors undergoing chemotherapy at one of three VAMCs who reported at least one core symptom at a moderate or high level and had a caregiver willing to enroll in the study were randomly assigned to either 10 weeks of CCP or 10 weeks of an attention control intervention. Patients and caregivers were surveyed at intake, 10, and 14 weeks. We reviewed all subjects' medical records for care received during the 14 weeks on study.

Results:
834 patients were referred to the study; 371 (45%) met eligibility criteria, of which 151 (41%) consented and were randomized; 137 (91%) entered the trial and 112 (82%) completed it. Caregivers receiving the intervention made a mean of 4.1 weekly task lists (range 0-10), with a mean of 4.6 tasks per list (range 1-10); 66% of the tasks were tried and, of those, 85% were rated as "helpful" by the caregiver. By 10 weeks, intervention subjects experienced lower summed symptom severity than controls did (mean 19.5 vs 23.2, P = 0.107). Intervention subjects also experienced fewer inpatient stays (mean 0.19 vs. 0.34, P = 0.1814) and phone calls to providers (0.46 vs. 0.62, P = 0.3019). Intervention subjects were able to tolerate more chemotherapy (agents per cycle 3.6 vs. 3.1 P = 0.0395; agents per infusion 2.2 vs. 2.0 P = 0.0054). Caregivers receiving the intervention reported less and similar mastery and burden as controls; most caregivers rated the intervention as "very helpful."

Implications:
We found that CCP can enhance caregiver support for Veterans, and that many Veterans experience better symptoms and adherence to chemotherapy as a result, ultimately requiring fewer formal resources during treatment. Cancer CarePartners does so with little burden to the caregiver. One limitation of the study is that recruitment rates were lower than expected.

Impacts:
This is the first trial to address the difficulties many Veterans face when attempting to manage their cancer symptoms by providing a mechanism so that any caregiver can be more informed about the Veteran's status and needs, and provide structured support in key areas. Programs like CCP might be able to help thousands of Veterans with cancer symptoms for-whom self-care is a challenge and who experience preventable morbidity and health service use as a consequence.