The purpose of this dissertation was to examine the concept of burden of treatment (BOT), from both a conceptual and operational perspective, within cancer patients with multimorbid conditions. BOT is the combination of a patient’s workload to manage their conditions, and the patient’s perspective of that workload and their conditions. Manuscript one was a conceptual analysis and development of a conceptual model focused on the BOT of cancer patients with multimorbid conditions. Manuscripts two and three were secondary data analyses that utilized data from a parent trial study. The parent trial was a multi-site, randomized controlled trial (RCT) that tested an adherence and symptom management intervention in cancer patients that were newly prescribed oral oncolytic agents (OOA) over 12 weeks. Manuscript two examined patients’ OOA acquisition, defined as the number of days from the time of initial prescription until patients received their drug. This manuscript also examined how baseline disease/treatment factors (OOA drug class) and healthcare system factors (insurance type, recruitment site, and OOA copay) might predict the time to acquisition. All 272 patients form the parent trial were included in manuscript two. The number of days to acquisition was collected from the patient during the baseline telephone interview. The sample was evenly split between males and females, had a mean age of 61 years (SD=12.2), and was primarily Caucasian (89%). Patients waited on average 9.73 days from the time of initial prescription to receive their OOAs (range 0-135 days). ANOVA results showed that those that had a copay waited longer to receive their OOA (P = .02). Additionally, there was a significant interaction effect between OOA drug class, insurance type, and OOA copay (P = .01). Simple interaction effects showed significant acquisition times for those prescribed kinase inhibitors, F (1, 114) = 6.709, p .01, and sex hormone inhibitors, F (1, 19) = 7.879, p .01, depending on the type of insurance and whether or not individuals had a copay. Manuscript three operationally tested the conceptual model developed in manuscript one. This chapter examined the direct relationship between baseline antecedent characteristics and temporary stoppages of patients’ OOA regimens. Additionally, BOT-indicator variables were examined for a moderation effect on this direct relationship. OOA regimen complexity was utilized for the patient workload component of BOT, while patients’ rating of their symptom interference on daily activities was used for patient perspective. More than 36% of patients in the parent trial experienced a temporary stoppage of their OOA regimen over 12 weeks. The moderation, interaction terms between BOT and multimorbidity were statistically non-significant. However, females (P = .02) and those prescribed kinase inhibitors (P < .01) were more likely to experience temporary stoppages when compared with males and other OOA drug classes, respectively. Burden of treatment is a recently developed concept that will be valuable to research and practice as the prevalence of individuals with cancer and multimorbid conditions continues to increase. An individual’s BOT can be related to the tasks required of them to manage their conditions, as well as the perspective they have about these tasks and conditions. This dissertation provided conceptual insight into the BOT experienced by cancer patients with multimorbid conditions, as well as the negative outcomes they may experience if their burden becomes too great. Patients may experience long wait times to receive cancer treatment that is vital, given their critical disease status. Although non-significant, there was a descriptive trend of more multimorbid conditions being associated with a greater proportion of temporary stoppages, as well as sex and drug class having an impact on these treatment modifications. The current literature does not adequately describe the burden of treatment experienced by cancer patients. Future research and practice guidelines are needed to help identify and ease the burden of treatment that individuals with cancer and multimorbid conditions experience.
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