The purpose of this study was to examine the effect of Cimicifuga racemosa (CR BNO 1055) on hot flashes caused by tamoxifen adjuvant therapy in young premenopausal breast cancer survivors. This treatment presents an off-label use of CR BNO 1055 (also known as black cohosh).

Participants took one tablet twice daily with meals for 60 days. Duration of treatment was five years for tamoxifen, and 12 months for CR BNO 1055. Participants were instructed not to initiate new therapies for hot flashes while participating in the study. Forty-six participants were randomly assigned (1-2) to receive tamoxifen 20 mg per day orally (usual-care group;mean age = 47 years); 90 participants received tamoxifen plus CR BNO 1055 corresponding to 20 mg of herbal drug (intervention group; mean age = 46 years.).

• The study enrolled 136 breast cancer survivors aged 35–52 years who completed treatment with segmental or total mastectomy, radiation therapy and adjuvant chemotherapy.
• Inclusion Criteria: Premenopausal status with regular menstruation and normal duration of cycle, and breast cancer diagnosis with estrogen receptor–positive tumor.
• Exclusion criteria: Refusal to consider a study treatment for relief of symptoms, history of other cancers, and history of serious chronic medical conditions.

This was a two-arm, randomized and open-label trial. The primary endpoint was to assess the effect of CR BNO 1055 on the frequency and intensity of hot flushes.

Control visits occurred every two months, when the supply of CR BNO 1055 was replaced and clinical assessments made. Hot flashes were considered severe when five or more heat episodes occurred during the day and were accompanied by sweating, sleep disturbances, feeling of irritation, and anxiety. A few episodes of heat with discrete sweating were classified as moderate hot flushes. Participants completed hot flash diaries at baseline, at every control visit, and at the end of the study at 12 months.

The hot flash patterns were significantly different between the two groups using Fisher’s exact test (p < 0.01). Among the 46 study participants included into the usual-care group, 73.9% experienced severe hot flushes and 26.1% moderate symptoms. Among the 90 study participants in the intervention group, at the end of the study, 46.7% were free of hot flashes, and 24.4% reported severe symptoms.

In the intervention group, the administration of CR BNO 1055 in combination with tamoxifen for a 12-month period significantly reduced the vasomotor episodes induced by tamoxifen in breast cancer survivors.

Methodologic problems included an open label trial  and unbalanced arms  (twice as many participants in the Black Cohosh group as in the usual care group).

The intervention consisted of 30-minute progressive muscle relaxation (PMR) sessions three times per week for five weeks versus massage therapy for five weeks versus a control group. Participants completed the State-Trait Anxiety Inventory (STAI) before and after the first and last sessions. Longer-term anxiety effect was examined by comparing pre first day and pre last day measures on the STAI and by the Symptom Checklist (SCL)-90R (revised) anxiety subscale administered on the first and last days of intervention. Blood samples were drawn to evaluate immune response for natural killer (NK) cell production, cytotoxicity, and hormone levels.

The study reported on three groups: PMR (n =  20), massage therapy (n = 22), and control (n = 16).

A three-group experimental study design was used.

• STAI
• SCL-90R

ANOVA on STAI revealed a significant (p < 0.001) group effect on the first day’s change scores; subsequent Bonferroni t tests revealed reduced anxiety scores for the massage and PMR groups when compared to the control group. The longer-term effects (SCL-90R subscale) did not differ significantly among the three groups. Massage therapy demonstrated an increase in dopamine, serotonin, NK cells, and lymphocytes.

This study supports the use of massage treatment and relaxation therapy to reduce anxiety, pain, and depression in women with breast cancer.

• The study had small sample sizes.
• It is not clear whether assignment to the three treatment groups was random, which limits the strength of the study.

The intervention was five weeks of massage therapy sessions for 30 minutes per session. Massages were given three times per week, for a total of 15 massages (control group).

• The sample had 34 participants.
• Both groups were comprised of women who had received surgery for breast cancer.
• The women had stage I or II breast cancer, diagnosed within the past three years, and were at least three months post any treatment.

A longitudinal randomized controlled trial design was used.

• State-Trait Anxiety Inventory (STAI) 
• Profile of Mood States (POMS)
• Symptom Checklist–90–Revised (SCL-90-R)
• Natural killer cell numbers and assays (blood) measured immediate- and long-term effects.

Anxiety was reduced in the massage group on STAI (p < 0.05) after the first and last sessions (decreased by 25%).

• Random assignment by flip of coin could have introduced bias; a random-number table could have been used to avoid this bias.
• The study had a small sample.

The purpose of the study was to compare the effectiveness of prophylactic G-CSF or GM-CSF with prophylactic antibiotics for the prevention of febrile neutropenia, severe infection, infection-related mortality, and overall mortality in patients of all ages with any type of malignancy receiving myeloablative chemotherapy.

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE databases were searched from January 1985 to January 2008, as were proceedings from the American Society of Clinical Oncology and the American Society of Hematology (2000–2007). In addition, references from identified trials, relevant reviews, guidelines, and ongoing clinical trials were searched.

Key words included  granulocyte–colony-stimulate factors (G-CSF), granulocyte macrophage–colony-stimulating factors(GM-CSF), antibiotics, cancer

Studies were included if they were randomized, controlled trials conducted from January 1980 to January 2008 comparing G-CSF or GM-CSF prophylaxis with antibiotic prophylaxis in patients with cancer receiving myeloablative chemotherapy.

Studies were excluded if they were non-randomixed and were quasi-randomized with information on perioperative infection prophylaxis, stem cell mobilization, and priming of malignant cells with G-CSF or GM-CSF.

10,924 abstracts and 473 full-text articles were reviewed.

Forty-four were considered for the review.

Two articles were included in the final review.

Subgroup analyses conducted for types of underlying malignancies, baseline risk factors for febrile neutropenia for infection, inpatient versus outpatient setting, type of treatment (chemotherapy, hematopoietic stem cell transplantation), types of growth factors administered, age, and antimycotic prophylactic administration.

It was not possible to conduct a meta-analysis as planned due to differences in outcomes among the two studies included in this review.

Studies that were excluded were made up of 36 trials that compared antibiotics and G-CSF prophylaxis to antibiotic prophylaxis alone, four trials that compared prophylactic antibiotics and growth factors to growth factors prophylaxis alone, one due to different chemotherapeutic agents used in each of the study arms, and one non-randomized study comparison. Therefore, only two studies fit the exact inclusion criteria.

• 195 randomized patients were included in this review.
• The sample size across studies ranged from 40–155 participants.
• Participants were adults with solid tumors (small cell lung cancer or breast cancer) who received either oral antibiotics (ciprofloxacin and amphotericin B or cotrimoxazole) or subcutaneous injections of G-CSF or GM-CSF.

In the two trials evaluated, both showed efficacy for use of prophylactic colony-stimulating factors (G-CSF or GM-CSF) or antibiotics for decreased risk of infection; however neither colony-stimulating factors or antibiotics proved better than the other in adults with solid tumors who received myeloablative chemotherapy. No differences were found for infection-related mortality, treatment-related or early mortality, febrile neutropenia, the incidence of severe infections, or infectious episodes.

The use of prophylactic treatment with G-CSF, GM-CSF, or antibiotics for the reduction of risk of infections among adults receiving myeloablative chemotherapy for the treatment of small cell lung cancer or breast cancer is effective; however, use of a colony-stimulating factor versus an antibiotic is inconclusive in terms of better efficacy. More trials are warranted to evaluate prophylactic antibiotic versus colony-stimulating factor use for reduced risk of neutropenia, febrile neutropenia, infections, hospitalizations, and survival.

Implications for nursing practice include knowledge of the known literature and lack of information available. Use of a prophylactic treatment (colony-stimulating factor or antibiotic) for infection prevention is warranted.

To compare the effects of ibandronate with those of pamidronate in patients with bone metastases from breast or lung cancer  

All patients were diagnosed with either breast or lung cancer and had scan-confirmed bone metastases. Patients were in one of two treatment groups, each receiving IV medication every four weeks for six months. Group A received 6 mg ibandronate. Group B received 90 mg pamidronate.

• The sample was composed of 25 patients.
• Mean patient age was 60.9 years.
• Of all patients, 28% were male and 72% were female.
• Fifteen participants had a primary diagnosis of breast cancer. Ten participants had a primary diagnosis of lung cancer.

The authors are practitioners at three facilities in Greece: General Hospital of Nafplio, General Hospital of Kos, and the Hellenic Medical Society for the Study of Psychosomatic Problems, Athens. The report does not specify that these were locations used in the study, however.

• Phase of care: active treatment
• Clinical applications: late effects, survivorship, end of life, palliative care
   

Comparative study

• A linear analog scale, 0–10, to assess pain, mobility, and quality of life (QoL)
• Patient's serum calcium-creatinine ratio, to measure bone resorption
   

Patient demographics were similar in both groups. At baseline, linear analog scale scores were similar in both groups. Compared to the pamidronate group, the ibandronate group had lower pain scores, higher mobility and QoL scores, and lower serum calcium levels. Patients who were taking ibandronate needed fewer analgesics (p = 0.001). In regard to bone pain, patients taking ibandronate reported scores in the range 0–1 and patients taking pamidronate reported scores in the range 3–4.

Ibandronate may be superior to pamidronate in alleviating pain, improving mobility and QoL, and reducing bone resorption in patients with bone metastases from breast or lung cancer.

• The study had a small sample size, with fewer than 30 participants.
• The study had a risk of bias due to no random assignment.
   

Evidence from this study strongly supported the effectiveness of bone-modifying agents in reducing the pain of patients with bone metastases. This study attempted to compare the effectiveness of different bisphosphonates. The size and limitations of the trial did not permit researchers to draw firm conclusions regarding the usefulness of one agent over another. Further research is needed to determine the relative efficacy of bone-modifying agents in pain control.

STUDY PURPOSE: To update the American Society of Clinical Oncology (ASCO) guidelines on the use of chemotherapy and radiation therapy protectants for patients with cancer

PHASE OF CARE: Active antitumor treatment

Using various chemotherapy/radiotherapy protectants is useful in certain malignancies for prevention of toxicity related to therapy. Future trials need to be blinded with placebo-controlled arms to provide key evidence to ensure safe guideline recommendations. 

Most of the trials lacked a placebo arm in the studies with the quality of the literature reviewed being limited. The panel found that different instruments and/or assessment tools varied for assessing the same outcome in multiple trials.

Nurses caring for this patient population need to be aware and understand that there are medications that can be given to prevent certain chemotherapy/radiation toxicities.

To determine if palifermin reduces severe oral mucositis (OM), defined as grade 3 or 4 on the World Health Organization (WHO) Oral Mucositis Grading Scale, in patients undergoing postoperative radiochemotherapy for locally advanced head and neck cancer

• This study had three arms. In arm 1, patients received 120 ug/kg palifermin per week during radiochemotherapy (at least seven doses). In arm 2, patients received 120 ug/kg palifermin per week for four doses, then placebo throughout the remainder of radiochemotherpy. In arm 3, patients received placebo throughout radiochemotherapy.
• Radiation therapy consisted of conventional or three-dimensional radiation planning for standard fractionation (5 X 2 Gy per week), for a total dose 60 Gy to 66 Gy. Chemotherapy consisted of 100 mg/m² cisplatin on days 1 and 22. Palifermin was administered once, three days prior to starting radiochemotherapy, followed by six once-weekly doses. 
• Local supportive care of normal saline rinses, topical anesthetics, feeding tube, and hematopoietic growth factors were allowed. Anti-inflammatory, antifungal, or antibiotic mouthwash solutions were not permitted.

• The study reported on 186 patients with a mean age of 56.5 years.
• The sample was 82% male and 18% female.
• Patients were resected for pathohistologically documented, high-risk Stage II to IVB squamous cell cancer of the oral cavity, oropharynx, hypopharynx, or larynx and were expected to receive at least 50 Gy to at least two of the main areas of the oral or oropharyngeal mucosa.
• Patients had European Cooperative Oncology Group (ECOG) performance status of 0–2, no history of pancreatitis or acute pancreatitis within the last year, and no prior radiation to the head and neck region or prior to chemotherapy.

This was a multisite study conducted in Australia, Canada, France, Germany, Italy, Spain, and United Kingdom.

Patients were undergoing the active treatment phase of care.

This was a double-blind, randomized, placebo-controlled trial.

• The WHO oral toxicity scale was used.
• Trained evaluators conducted twice weekly assessments (at least 3±1 days apart throughout radiochemotherapy) until resolution of OM to WHO grade 2 or lower or until week 15.
• If OM was not resolved by week 15, weekly assessments were continued until OM reached grade 0 or 1 or until week 24.
• Evaluations immediately analyzed for data quality and accuracy by Clinical Assistance Programs.

• The four-arm palifermin arm was halted because of slow enrollment. Results for the 38 patients on this arm were analyzed separately and matched for the first 38 patients enrolled in the placebo arm.
• Palifermin at 120 ug/kg reduced severe OM in patients with head and neck cancer undergoing concomitant postoperative radiochemotherapy.
• Severe OM was observed in 47 (51%) in the palifermin arm and 63 (67%) in the placebo arm (p = 0.027). The median durations of severe OM were 4.5 days in the palifermin arm and 22.0 days in the placebo arm (p = 0.037). The median times to develop severe OM were 45 or 21 days (p = 0.022) in the palifermin and placeblo arms, respectively.

Palifermin administered prior to initiation of and weekly during concurrent chemotherapy-radiation therapy reduced OM incidence. The study also examined secondary endpoints (i.e., duration and onset, xerostomia, mouth and throat soreness (MTS) score) as well as radiation treatment breaks and chemotherapy delays. Patients receiving palifermin did not experience fewer breaks or lower average MTS  even though these patients did receive fewer opiod analgesics.

This study was supported by Amgen, which manufactures paliferrmin.

Treatment-related OM is debilitating for patients with head and neck cancer undergoing concurrent chemotherapy-radiation therapy. This can significantly impact patient comfort, nutritional status, and response to therapy. Further research is needed to identify effective therapies to better protect the oral mucosa.

To formally evaluate whether a tailored and experiential training approach by an experienced nurse would enhance confidence (self-efficacy) of family cancer caregivers to provide home care and manage patients’ symptoms of illness

The study principal investigator (PI) provided a conceptually based, tailored, and patient-centered bedside intervention for family caregivers providing home care to patients with hematologic malignancies. Caregiver training included symptom management on prevention of infection, pain, poor nutrition, constipation/diarrhea, and management of medications for patient cancer symptoms. Interactive discussion on these topics occurred between interventionist (experienced nurse), caregiver, and patient. To encourage patient involvement in problem-solving symptoms, dyad participation was also incorporated into bedside training. Caregivers received an illustrated take-home manual on discussed topics. Discussion focused on nonpharmacologic interventions to improve patient comfort and meet other patient needs. Caregivers provided a return demonstration following nurse delivery of didactic teaching and skill performance (e.g., catheter care management) specific to patients’ home situation. Sufficient time was provided in the teaching encounter for patients and caregivers to ask questions and to allow satisfactory completion of the skills required for effective patient home care before patient discharge.

Assessment of the influence of the intervention occurred before and after PI training and one week following hospital discharge of the patients. Caregivers completed postintervention assessment within 24 hours of the PI’s didactic and skill performance presentation to caregivers.

• The sample (N = 16) was 15% male and 85% female.
• Sample age range was 44–80 years.
• Mean age was 62 years for both patients and caregivers.
• All patients had hematologic cancers and were admitted for chemotherapy or treatment of cancer-related acute conditions.
• Caregivers were connected to patients who were likely to be discharged soon and who were not actively dying; lived with patients in the same home and served as primary caregivers; and were English speaking and reading.
• The majority of caregivers were white and did not work outside the home; almost half were educated at the associate degree level or higher.

• Single site
• Multiple settings
• Southeastern U.S. regional medical center

Active antitumor treatment phase

A quasi-experimental, time-series design was used.

• Cancer Caregiver Self-Efficacy (Confidence) Questionnaire (CCSE): This 23-item tool was used three times in the study to assess caregiver confidence in completing a behavioral task or skill.
• No prestudy reliability and validity indices were reported.
• Cronbach’s alpha was 0.94 for the CCSE. Construct validity index of 0.77 (p < 0.001) was reported for the CCSE when the scores from the study sample of 16 were correlated with historical data including the Caregiving Preparedness Scale.

Total caregiver CCSE scores were significantly higher immediately after caregiver training (z = 4.49, p < 0.001) and one week after hospital discharge of patients (z = 3.22, p < 0.001). These higher scores reflect higher and some sustained levels of caregiver confidence to provide needed home care to patients comprising the sample. Although unanticipated, four patients died within one week of hospital discharge (20% attrition for study), producing a total sample of 16 from the initial sample of 20 patient–caregiver dyads for the one-week assessment.

Timely assessment and nurse-led interventions relevant to assessment findings may increase caregiver confidence to assume home care for patients with hematologic malignancies. Based on Bandura’s (1986) conceptual self-efficacy framework, this pilot study suggests that nurse-led individualized teaching and modeling of homecare skills at the patient’s bedside prior to discharge can sustain caregiver confidence for up to one week postdischarge of the patient. Caregivers and patients believed the intervention to be highly beneficial based on a 1:1 relationship with the nurse-teacher.

• The sample was small, with less than 30 participants.    
• Risk of bias existed because of no control group, no blinding, and no appropriate attentional control condition.
• Unintended interventions or applicable interventions that would influence results are not described.
• Findings are not generalizable.
• Subject withdrawals were greater than 10%.
• Involvement of the PI or study staff with the rounding oncologist during prerecruitment may have influenced individuals approached for the study (Were those with greatest needs referred for the study?)
• The acuity level of the sample patients and the functional health of caregivers to support their ability to provide home care are unknown.
• Whether training occurred the day of discharge or how variable the timing and length of the intervention was are unclear.
• Whether data from the 20 subjects were used in the pre- and post-analysis and then from the 16 for the pre-one week, or whether the 16 were used for all analysis, is unclear. The analysis section suggests that a mixed-effects model was used, suggesting that all data were used and missing data were modeled. More manuscript details would aid in interpretation of the study findings.
• Threats of maturation and selection also may affect internal validity of the study.

As part of their education, nurses learn about the teaching-learning process to optimally prepare patients, families, and communities about ways to improve personal and societal health. With early discharge of patients and the need for family members to often assume complex caregiving roles, there is a heightened need for nurses to use their knowledge of teaching-learning to assess and implement effective teaching to families during the cancer trajectory. Individualized and bedside teaching approaches, such as those found in this study, benefit patients and family members in both inpatient and outpatient settings. Study findings must be evaluated with caution due to the small sample size, one setting for data collection, and lack of control group. More specifically relative to sample size, additional replication of the study must occur to more clearly identify the influence of the individualized and experiential training program on diverse population groups related to ethnicity, clinic care type, education level, and gender (external validity). This would capture deeper understanding of needed components of tailored care in the healthcare team approach to efficiently meet caregiver and patient needs.

To examine the effects of enhanced training on caregivers’ self-efficacy in managing patients' symptoms, stress, preparedness for caregiving, depression, and anxiety

Researchers structured and used enhanced caregiver training (CT) that taught caregivers how to manage patients’ symptoms and their own stress. This training added distress management to previously developed training that focused on managing patients' symptoms only. Training was done at the patients' bedside, one on one, with dyads (patients and their caregivers), and required one to two hours. Training on symptom management involved a manual process that started with a needs assessment to tailor the training to the patient’s situation, an interactive discussion that involved both the patient and the caregiver about how to manage symptoms, and concluded with a one-page hand out on each symptom. Training related to caregivers’ stress management involved a three-step behavioral rehearsal procedure. The nurse modeled how to implement the skill, and the caregiver practiced the skill and received constructive feedback. Finally, the caregiver practiced until she or he mastered the skill.

• N = 38 (intervention); 38 (control)
• AVERAGE AGE = 55 years (caregivers)
• MALES: 18%, FEMALES: 82%
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of caregivers were adults, Caucasian, married, had at least some college education, and were the spouses of patients. The majority had a high level of health literacy, and the average length of caregiving was 19 months. A dyad was excluded if a patient was under hospice care.

• SITE: Single site    
• SETTING TYPE: Inpatient  
• LOCATION: Duke University Health System Oncology Units

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care

Randomized, controlled trial in which the intervention arm received enhanced CT and the control group received information about community resources

• Modified Caregiver Self-Efficacy Scale (CaSES) to assess confidence in caregiving abilities (13 items) and in stress management (one item)
• The Preparedness for Caregiving Scale (PCS), a subscale of the Family Caregiving Inventory (FCI)
• Profile of Mood States (POMS) to assess anxiety
• Center for Epidemiologic Studies–Depression (CES-D) scale
• Caregiver Reaction Assessment (CRA) to assess caregiver burden
• Rapid Estimate of Adult Literacy in Medicine (REALM-R) to assess health literacy

Significant difference was identified between the intervention and control groups in self-efficacy for managing patients' symptoms, caregiver stress, preparedness for caregiving immediately after the intervention. The intervention group scored higher on the previous outcomes. No differences in other outcomes were found, and the differences initially observed after the intervention were not sustained at two and four weeks after discharge.

Enhanced CT improved caregivers’ self-efficacy, stress management, and preparedness for caregiving immediately after the intervention. However, it did not lead to significant changes in anxiety, depression, or burden. No sustained effects of the intervention were observed for any outcomes.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: This was a well done trial despite the identified limitations.

Caregiver training given in a single dose may not be the best approach to improving caregiver outcomes. Training or interventions for caregivers should be tailored based on emerging needs after discharge, and they should not be exclusively based on the observed or anticipated needs prior to a patient's discharge from the hospital.

To (a) investigate the effects of an individualized caregiver training intervention on a caregiver’s self-efficacy in home care and symptom management, and (b) identify whether caregiver training would affect a caregiver’s psychological well-being (depression, anxiety, and quality of life)

After signing informed consent, dyads completed baseline questionnaires and were randomly assigned to either a treatment group or a control group. Interactive nurse–caregiver training for one to two sessions was offered when discharge was imminent. Immediately after caregiver training, caregivers completed questionnaires on self-efficacy. Follow-up questionnaires for caregivers and patients were completed at one week, two weeks, and four weeks after hospital discharge of patients.

The caregiver training intervention provided caregiver training for managing patients’ cancer symptoms with four major components: (a) prevention of infection, (b) pain control, (c) maintenance of nutrition, and (d) adequate elimination. The program was manualized, including a book for caregivers with “how to” pictures. Additional time and content were allocated to address specific homecare issues identified by caregivers. The training followed a consistent outline, but information shared was specific to needs of the patient and caregiver.

The control intervention consisted of an interactive nurse–caregiver standardized, manualized one-two session intervention focused on information about community resources for caregiving. This included but was not limited to home health agencies, respite care, and caregiver support services.

• The sample included 120 patient dyads (60 in treatment group and 60 in control group).
• Of the caregivers, 48% were 46–64 years of age; of the patients, 54% were 60–69 years of age.
• The caregiver sample was 17% male and 83% female; the patient sample was 71% male and 29% female.
• Patients had hematologic malignancies.
• Of the caregivers, 84% were white, 89% were married, 60% had education beyond high school, 64.6% were not working outside the home, and the patient for whom they cared was a spouse.
• Of the patients, more than 80% were white, 88% were married, and almost 90% had education beyond high school.

• Single site
• Outpatient setting
• Duke University Hospital in Durham, NC

• Multiple phases
• Home care; after hospital discharge; survivorship

A randomized controlled trial design was used.

• Lorig’s Self-Efficacy Scale: Noted prior assessed reliability (0.94) and validity
• Hospital Anxiety and Depression Scale (HADS): No noted prior reliability and validity
• Older Americans Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire (Instrumental and Physical subscales): No noted reliability and validity
• OARS Comorbidity Scale: No noted reliability and validity indices
• Caregiver Quality of Life–Cancer Scale (CQOLC): Noted earlier assessed internal consistency of 0.91   
• Memorial Symptom Assessment Scale (MSAS): No noted reliability and validity

There was increased self-efficacy immediately following the caregiver training intervention and higher self-efficacy and symptom management at four weeks after the intervention when compared to the control group. A significant group-by-time interaction (p = 0.008) was present in the training intervention caregiver group that showed decreased depression scores from baseline to time 3 (one week). However, significant differences between treatment and control groups were not found after time 3. A similar result occurred when analyzing the effect of the intervention on caregiver anxiety. In terms of the effect of the caregiver intervention on patient’s physical symptoms, the overall intervention over time did not significantly improve symptoms. There was also no significant effect of the intervention on caregiver quality-of-life scores in both the control and caregiver training groups.

Caregivers have a major role in the outcome of a successful transition from hospital to home. This study provides information about caregiver training that improved their self-efficacy when addressing symptom management of a family member with cancer. More research is needed to determine the most effective caregiver training to manage patients’ symptoms at home.

• Nurses delivering the caregiver training intervention and the control intervention were not blinded.
• Assessment of the delivery of control and caregiver training intervention did not occur.
• The sample was mostly white, educated, and married.
• Caregivers were not observed providing actual home care and symptom management interventions.

Caregiver training for the patient’s home care and symptom management is critical in bridging the transition for patients from hospital to outpatient care. Nurses play a key role in this caregiver training tailored to specific caregiver and patient needs. Evidence-based information about the most effective training, including decisions about frequency, dosing, timing, formatting of information, and preparation of the nurse, is needed to improve caregiver quality of life and psychological well-being.