Unplanned healthcare use and self-efficacy for managing symptoms during oral anticancer therapy

Context Oral anticancer agent (OAA) use in cancer treatment necessitates patient symptom self-management, which requires self-efficacy. Appropriate management may deter costly and burdensome unplanned healthcare use. Objectives To assess self-efficacy for managing symptoms over time in patients taking targeted OAAs, and to evaluate associations between self-efficacy, symptom severity, and unplanned healthcare use. Methods We conducted a prospective cohort study of participants initiating OAAs, following them for approximately the first eight months of therapy. Participants completed patient reported outcome measures (PROMs) online at six timepoints. Descriptive statistics quantified demographics, cancer characteristics, symptoms, self-efficacy for managing symptoms, and unplanned healthcare use. Logistic regression models estimated whether unplanned healthcare service use was associated with self-efficacy for managing symptoms and symptom severity. Mixed effects logistic regressions were used to account for repeated measures and time effects. Results Fifty-nine participants (95%) completed the first set of PROMs within three weeks of starting therapy; about eight months later, 29 (47%) completed the sixth and final set. Participants were mostly White (90%) and female (61%). Twenty-four unique participants (41%) used unplanned healthcare 38 times. Multivariable adjusted odds of unplanned healthcare use were lower for participants with above versus below average self-efficacy (OR 0.24; 95% CI 0.11-0.53), but higher with each one-point increase in pain severity (OR 1.29; 95% CI 1.11-1.51). Conclusion Unplanned healthcare use was associated with lower self-efficacy for managing symptoms and greater pain severity. Clinicians should redouble efforts to assess and manage pain proactively. Assessing self-efficacy to deliver targeted support to patients may potentially reduce unplanned healthcare use.