Symptom Management Strategies You May Not Be Using

June 13, 2024 by Deborah Christensen MSN, APRN, AOCNS®

Oncology nurses are frontrunners in identifying and managing symptoms experienced by people with cancer. From communication approaches and apps to integrative interventions, today’s tools can help nurses more efficiently assess and address side effects, thereby improving patient care.

Communication Approaches

Conversational assessment (https://voice.ons.org/news-and-views/use-conversational-assessments-to-deliver-whole-person-care) (CA) is an organic way to identify and manage patients’ physical and emotional symptoms that may not be fully captured using a typical assessment scale. CA prioritizes understanding individuals’ core needs to ensure that their care and support align with their personal preferences. Fostering a relaxed and open dialogue encourages (https://www.thinklocalactpersonal.org.uk/_assets/Resources/Using-conversations-to-assess-and-plan-peoples-care-and-support.pdf) creative solutions and may empower (https://www.thinklocalactpersonal.org.uk/_assets/Resources/Using-conversations-to-assess-and-plan-peoples-care-and-support.pdf) individuals to better manage their symptoms.

Validated patient-reported outcome tools can guide nurses in adequately covering symptoms during CAs. For example, the Therapy-Related Symptom Checklist (http://dx.doi.org/10.1097/NCC.0b013e3182595406) is a validated way for adults and children to self-report symptom occurrence and severity on a scale of 0–4. Other scales include the Edmonton Symptom Assessment (https://doi.org/10.1001/jamanetworkopen.2021.17295) tool and MD Anderson Symptom Inventory (https://www.mdanderson.org/research/departments-labs-institutes/departments-divisions/symptom-research/symptom-assessment-tools/md-anderson-symptom-inventory.html).

Best practice involves performing (https://www.thinklocalactpersonal.org.uk/_assets/Resources/Using-conversations-to-assess-and-plan-peoples-care-and-support.pdf) CA as a distinct, concentrated conversation. Nurses must employ creative strategies to integrate this personalized approach effectively, and the time and skill required may limit its use.

Examples of Symptom Tracking Applications

Bearable Symptom Tracker (https://bearable.app/): Allows patients to monitor a wide array of health metrics and add custom symptoms as needed.

Cancer Center–Specific and Electronic Health Record Portals: Many cancer centers have applications and patient portals where patients can log symptoms and communicate with providers.

Carevive PROmpt (https://www.carevive.com/carevive-launches-native-app-carevive-prompt-patient-engagement-platform/): Gives patients remote access to their health data and symptom log in real time, even between clinic appointments. Integrates with electronic health record systems.

LivingWith (https://www.thisislivingwithcancer.com/living-with-app): Patients can manage health information, track well-being, and coordinate support throughout their cancer journey.

Outcomes4ME (https://outcomes4me.com/): Patents with breast cancer can track and manage symptoms, learn about breast cancer clinical trials, genetic testing, and more. The app integrates with National Comprehensive Cancer Network guidelines.

Digital Tools and Resources

Digital self-management support tools such as websites, apps, and smartwatches help patients (https://doi.org/10.2196/20861) track and address their symptoms. The tools aid in disease management, promote healthy habits, and provide the healthcare team with information and health trends. They also help patients monitor their symptoms’ duration and severity over time, leading to a comprehensive view rather than a single snapshot. During patient and caregiver conversations, nurses can use the reports to clarify the symptom experience.

A patient’s digital literacy level (https://voice.ons.org/news-and-views/personalized-patient-education) may be a barrier to using digital tools, and the quality of cancer self-management apps varies widely. Nurses can use the Mobile Application Rating Scale (https://pdfs.semanticscholar.org/959b/3526bbd2c3a46ee3b729590a41d6516f77f3.pdf) to evaluate an app’s value in terms of engagement, functionality, visual design, and information quality. See the sidebar for some examples of symptom management apps.

Integrative Medicine

People with cancer may be interested in exploring integrative approaches such as yoga, acupuncture, and the use of cannabis products. Current research findings support (https://doi.org/10.53388/tmrnd20220531010) the benefits of yoga in managing a spectrum of symptoms, from emotional distress to sleep disturbances. Similarly, acupuncture has been clinically recognized (https://doi.org/10.1136/bmjspcare-2020-002638) as an effective modality for controlling various treatment-related side effects like nausea and neuropathic pain.

Between 25% and 40% of people with cancer report using (https://doi.org/10.1002/cncr.30879) cannabis in some capacity to help alleviate symptoms. The Journal of Nursing Regulation released the NCSBN National Nursing Guidelines for Medical Marijuana (https://www.ncsbn.org/public-files/The_NCSBN_National_Nursing_Guidelines_for_Medical_Marijuana_JNR_July_2018.pdf) to provide evidence-based nursing recommendations regarding its use. Nurses must also be aware of state regulations where they practice. The National Conference for State Legislatures outlines (https://www.ncsl.org/health/state-medical-cannabis-laws) each state’s medical cannabis laws.

Many approaches can be used to assess and address symptoms and side effects associated with cancer and cancer treatments. The ongoing need for additional research and development of new symptom-management tools and guidelines is an opportunity for nurse scientists and clinicians to partner to improve the quality of life for individuals at all stages of cancer treatment and survivorship.

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