New Study Evaluates Communication About Chemotherapy-Induced Anemia And Fatigue In Clinical Settings

A new observational study published in the January issue of the Journal of Supportive Oncology shows that most discussions between cancer patients and community-based oncologists lack the specificity necessary to create a clear understanding of how anemia and related fatigue affects patients' daily lives. The study found this to be the case even though 52 percent of office-visit time with oncologists is spent discussing chemotherapy-related symptoms and side effects of treatments.

The study, "Communicating About Chemotherapy-Induced Anemia," was supported by Ortho Biotech Products, L.P. to capture naturally occurring conversations between clinicians and patients undergoing chemotherapy. The study observed 15 oncologists, 12 allied health professionals ranging from medical assistants to oncology certified nurses, and 36 cancer patients interacting during regularly scheduled office visits in five different states. All of the participating community-based oncologists had experience in treating chemotherapy-induced anemia in patients with most types of cancer. Anemia is a potentially life-threatening side effect experienced by more than 60 percent of cancer patients undergoing chemotherapy.

The findings showed that discussions of anemia and related fatigue are routine but minimal; that vocabulary describing side effects is imprecise, resulting in dialogues that do not reflect the patient experience; and that fatigue instruments such as Functional Assessment of Cancer Therapy-Anemia (FACT-Anemia), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and Linear Analog Scale Assessment (LASA) or other clinician question guides are not used in conversations. The study also revealed that the allied health professionals frequently had longer and more engaged conversations about side effects with patients than the oncologists.

As a result of these findings, the study's authors encourage oncologists to:

-- Modify their vocabulary and consider incorporating a validated fatigue instrument, either within or prior to the patient consultation;

-- Improve the quality of communication and enhance best practices; and

-- Systematize the role of allied health professionals in tracking and treating the impact of anemia and related fatigue on patients' lives to further clinicians' understanding of the true nature of the patient's condition.

"Chemotherapy-induced anemia is a potentially debilitating condition that many cancer patients struggle with during treatment," said Heidi E. Hamilton, PhD, associate professor, department of linguistics, Georgetown University, who designed the methodology for the anemia study and worked on its analysis. "Some patients may be reluctant to discuss the symptoms of anemia with their doctors because they believe it is a part of their cancer experience. By modifying vocabulary and changing the nature of discussions with patients, oncologists can play an important role in proactively improving the quality of communication with their patients and therefore, help to enhance patient care."

Detailed Study Findings

While the subject of anemia and fatigue was addressed in 34 of the 36 analyzed visits and clinicians initiated the discussion in 27 of those 34 visits where anemia and fatigue were addressed, the discussions were not sufficiently long or detailed enough to create a clear understanding of the consequences of the patient's anemia and related fatigue. The average visit contained 5 minutes, 57 seconds of conversation. The average anemia-specific discussion, excluding related issues such as fatigue or general side effects, was 43 seconds.

Across the 36 visits, the conversations also tended to be minimally interactive, with providers asking a total of 31 anemia-related questions -- an average of 0.86 anemia-related questions per visit -- which is notably fewer than validated fatigue instruments contain for assessment. In addition, 90 percent, or 145 of 162 of all side effect questions, and 87 percent, or 27 of 31 of all side effect questions specifically about anemia required only a yes-or-no answer, therefore limiting the patient's ability to convey his or her full experience.

In addition to the lack of engagement about the topic of anemia and related fatigue, the study found that conversations tended to focus on how the patient feels at the present time with few references to how they might have felt in the past and literally no references to goal-setting, or how they would hope to feel in the future.

At a vocabulary level, the use of multiple everyday, near-synonyms, such as "tired" "weak" and "worn out," on the part of the clinicians to describe the clinical term "fatigue" leaves a great deal of room for interpretation and adds to confusion on the part of patients about what exactly is meant by "related fatigue" with respect to anemia. The study suggests that focusing on the patient's activities or numeric scores from fatigue instruments provides a more accurate assessment.

"Anemia is a manageable condition," said Dr. Hamilton. "We encourage patients and doctors to discuss its signs and symptoms so that patients can get the treatment they may need."

About "Communicating About Chemotherapy-Induced Anemia"

The "Communicating About Chemotherapy-Induced Anemia" study was developed by Ortho Biotech Products, L.P. to analyze the frequently overlooked area of how healthcare providers actually discuss the quality of life impact of chemotherapy-induced anemia and related fatigue with patients. MBS/Vox, a research consultancy in Parsippany, N.J. that studies and analyzes how patients and physicians interact, conducted the study.

A total of 15 oncologists (6 medical oncologists, 9 hematologist/ oncologists), 12 allied health professionals, (whose certifications ranged from medical assistant to oncology certified nurse), and 36 patients participated in the study. Practices were observed in New York, New Jersey, California, North Carolina, and Florida during July and August 2004. Of the participating patients:

-- 53% were female, and the average age was 62.3 years.

-- 31% had a breast cancer diagnosis

-- 17% had a colorectal cancer diagnosis

-- 15% had a lung cancer diagnosis

None of the participants were aware of the study sponsor or the specific focus of the study. They were told only that it was a study on communication and chemotherapy, with a focus on chemotherapy-induced side effects. After agreeing to participate in the study, the 36 patients undergoing chemotherapy were videotaped and audio taped during their regularly scheduled visits. Interviews following these office visits were conducted separately with patients and participating providers. Interviews were transcribed and analyzed using accepted techniques in the field of sociolinguistics, the study of how language is used in social situations, with a goal of evaluating how patients and physicians referred to and discussed chemotherapy-induced anemia. These techniques included an analysis of the words used to describe the condition, as well as the context in which they were discussed.

About Chemotherapy-Induced Anemia

Anemia is a potentially life-threatening side effect experienced by more than 60 percent of cancer patients undergoing chemotherapy. Chemotherapy drugs kill rapidly dividing cells in the body, including cancer cells and normal cells, such as cells in the bone marrow, responsible for red blood cell production. Red blood cells carry oxygen, which acts like fuel for the body providing energy for muscles and organs to work. Common symptoms can include tiredness, shortness of breath, dizziness, and inability to concentrate.

About PROCRIT(R) (Epoetin alfa)

PROCRIT(R) (Epoetin alfa) is for the treatment of chemotherapy-induced anemia in patients with most types of cancer. PROCRIT is available by prescription only and is injected by your doctor or nurse.

Important Safety Information

PROCRIT is not for patients with uncontrolled high blood pressure. High blood pressure has been noted rarely in cancer patients treated with PROCRIT and blood pressure should be monitored carefully. Drugs like PROCRIT may increase the risk of serious heart-related events (including death) and blood clots. While on PROCRIT therapy, if you suddenly feel very tired or become very pale or dizzy, tell your doctor right away because it may be a sign of a very rare but serious condition. In studies, the most common side effects included fever, diarrhea, nausea, vomiting, edema (swelling), shortness of breath, tingling, and upper respiratory infection.

Please visit http://www.procrit.com for full Prescribing Information.

About Ortho Biotech Products, L.P.

Ortho Biotech Products, L.P. is a leading biopharmaceutical company devoted to helping improve the lives of patients with cancer and with anemia due to multiple causes, including chronic kidney disease. Since it was founded in 1990, Ortho Biotech and its worldwide affiliates have earned a global reputation for researching, manufacturing, and marketing innovative products that enhance patients' health. Located in Bridgewater, N.J., Ortho Biotech is an established market leader in Epoetin alfa therapy for anemia management. The company also markets treatments for recurrent ovarian cancer, rejection of transplanted organs, and other serious illnesses. For more information, visit http://www.orthobiotech.com.

Ortho Biotech Products, L.P.
http://www.orthobiotech.com