Kearney, N., Miller, M., Maguire, R., Dolan, S., MacDonald, R., McLeod, J., . . . Wengström, Y. (2008). WISECARE+: results of a European study of a nursing intervention for the management of chemotherapy-related symptoms. European Journal of Oncology Nursing, 12, 443–448.

To evaluate the impact of a nursing intervention incorporating structured symptom assessment and management of the chemotherapy-related symptoms of nausea, vomiting, fatigue, and mucositis.

A consecutive sample of 249 patients, who were scheduled to receive first-line chemotherapy, received structured symptom assessment and management, facilitated by WISECARE+, an information technology–based program. Symptom data was self-report by patients using a paper questionnaire for 14 consecutive days following each cycle of chemotherapy, starting on the first day of treatment.

• In total, 249 patients (22.9% male, 77.1% female) were included.
• Age was 15 to 85+ years.
• Patients had breast, lung, ovarian, or colorectal cancer; osteosarcoma; acute myeloid leukemia (AML); acute lymphoblastic leukemia (ALL); or lymphoma.
• Patients were chemotherapy-naïve, physically and psychologically fit adults.

• Multisite
• Inpatient and outpatient
• Pan-European:  eight clinical sites in Belgium, Denmark, England, Ireland, and Scotland

Patients were undergoing the active treatment phase of care.

The study used a pre- and postintervention design.

• The Chemotherapy Symptom Assessment Scale (C-SAS) rigorously tested for criterion validity, construct validity, test-retest reliability, and internal consistency (a = 0.75).   
• WISE Tool (electronic patient and symptom record/database):  No validity or reliability data were provided.

Patients experienced less nausea postintervention, but pre/post differences were only significant at days 0 to 4 (p = 0.025). Similarly, patients had less vomiting after the intervention but pre and post differences were only significant at days 0 to 4 (p < 0.001). Although changes in oral problems varied at different time points in the study, overall repeated measures analysis showed reduction in oral problems over the course of the study (p = 0.016). There was no effect of the intervention on fatigue.

Structured nursing symptom assessment and management of chemotherapy-related symptoms improved the symptoms of nausea, vomiting, and oral problems (mucositis) related to chemotherapy.

• No appropriate control group was used.
• The study sample was extremely heterogeneous, and the study was possibly underpowered.
• The study did not evaluate interventions specific to mucositis but, rather, the format or structuring of interventions. The study was not designed to specify if the oral problems were strictly mucositis.

The study used patient-assessed symptom data that was collected in real time. The data measured the incidence, severity, and associated distress of the symptoms. Additional research is needed to evaluate the effectiveness of the structured symptom assessment and management of chemotherapy-related symptoms.