Duggleby, W., Williams, A., Holstlander, L., Cooper, D., Ghosh, S., Hallstrom, L. K., . . . Hampton, M. (2013). Evaluation of the living with hope program for rural women caregivers of persons with advanced cancer. BMC Palliative Care, 12(1), 36.
To investigate the results of a Living With Hope Program on rural female caregivers‘ self-efficacy, hope, quality of life, and loss and grief when caring for persons with advanced cancer
Components of the Living With Hope Program included caregiver viewing of a Living With Hope video and journaling centered on “Stories of the Present” over a two-week period. Journaling focused on caregiving challenges and experiences supportive of hope in the caregiving experience. Measures assessing caregiver demographic data, hope, self-efficacy, quality of life, grief, and journaling time were collected at baseline, one week, two weeks, and 3, 6, and 12 months. Trained RNs collected baseline and one- and two-week data in caregiver homes and then by telephone at 3, 6, and 12 months. Convenience sampling produced an initial N of 36 but because of attrition based on uncontrolled factors dropped to 22 by the 12-month measurement time.
HHI scores at day 7 and 14 were significantly higher than baseline values (p = 0.013), and GSES scores were significantly higher at all data points compared to baseline values (p < 0.04). SF-12v2 physical summary scores were significantly lower at 12 months than at baseline (p = 0.04), but instrument mental scores at 3 and 12 months were significantly higher than at baseline (p < 0.03). A positive correlation between GSES and HHI scores (p < 0.001) and a negative correlation between NDRGEI and HHI scores (p = .0.01) was found. HHI and NDRGEI scores significantly predicted caregiver mental health summary scores (p = 0.01 or less) and similar physical health scores (p < 0.04). All caregivers completed the Living With Hope intervention with a mean 4.18 (SD = 4.07) journal entries per week and an average journal composition time of 9.12 minutes (SD = 8.89 minutes). Qualitative analysis data supported the value of journaling, social support, and faith and spirituality in responding to caregiver challenges with accessing care, financial issues, and caregiver health.
Study findings suggest that the Living With Hope Program may increase hope in rural female caregivers of people with advanced cancer who are receiving palliative care services. The study's small sample size, convenience sample, limited journaling exercise, and inherent threats to internal validity (e.g., history, selection, maturation) due to study design support further studies of the Living With Hope Program as an evidence-based psychosocial intervention for caregivers of patients with advanced cancer.
Clinicians benefit from examining interventions, such as the Living With Hope Program, that improve caregiver hope via increasing self-efficacy and minimizing feelings of loss and grief with advanced cancer family member care. Study results that rural caregivers experience poorer physical and mental health than the general population also support clinician attention to caregiver health issues during care encounters.
Duggin, K., Tickle, K., Norman, G., Yang, J., Wang, C., Cross, S.J., . . . Mandrell, B. (2014). Aprepitant reduces chemotherapy-induced vomiting in children and young adults with brain tumors. Journal of Pediatric Oncology Nursing, 31, 277–283.
To determine if a 5HT3 receptor antagonist and aprepitant, an NK1 antagonist, without a corticosteroid were effective in reducing vomiting in pediatric patients with brain tumors receiving highly emetogenic chemotherapy (HEC)
This retrospective chart review investigated all patients (young adults and children) receiving the medulloblastoma protocol who were prescribed a 5HT3 antagonist plus aprepitant without a corticosteroid during their first course of HEC from September 9, 2003 to March 12, 2010. All cases were matched with two controls who received 5HT3 plus a corticosteroid.
Single-institution retrospective chart review
The control group experienced grade 2 or higher chemotherapy-induced vomiting when compared to aprepitant recipients. When controlling for variables such as risk, age, and gender, patients who did not receive aprepitant were significantly more likely to have grade 2 or higher vomiting during the first course of HEC than aprepitant recipients.
There is limited literature documenting chemotherapy-induced nausea and vomiting among pediatric patients, and this study provides helpful information to investigate the role of aprepitant. Prospective studies including patient-reported outcomes would be helpful in characterizing the benefits of aprepitant. The ability to better control chemotherapy-induced nausea and vomiting without the use of steroids is very beneficial.
Ducloux, D., Guisado, H., & Pautex, S. (2013). Promoting sleep for hospitalized patients with advanced cancer with relaxation therapy: experience of a randomized study. The American Journal of Hospice and Palliative Care, 30, 536–540.
To measure the efficacy of relaxation training for hospitalized patients with advanced cancer.
Patients were randomized to receive an immediate or delayed intervention, on day 3 or day 6 of a nine-day study period. The intervention was a one-hour training session delivered by a specially trained registered nurse (RN) in deep breathing and somatic tension release, as well as instruction on maintaining a state of somatic relaxation. Patients were given a CD of the audio training to repeat at night after the training.
This was a pilot, randomized, controlled trial.
Only 11 patients were able to complete the treatment phase of the study. Both groups improved (not statistically) between the day of inclusion and day 2 of therapy. No improvement occurred between days 2 and 5, which was when the intervention occurred for half of the patients. No change occurred in the use of benzodiazepines during the nine-day study.
The study did not show that a simple relaxation therapy intervention improved satisfaction with sleep in patients with advanced cancer hospitalized on a palliative care unit.
Assessment and management of sleep disturbances should be integrated into patient care early in the disease process. Further work is needed to identify and test interventions that can be used to improve sleep in patients with advanced cancer. Further work is also needed to determine whether relaxation therapies have an effect on sleep satisfaction.
It is critical to assess and manage sleep disturbances in patients with cancer early in the disease process. Ongoing evaluation and research is required into effective interventions to promote sleep in patients with cancer; specifically, further work is needed to look at relaxation therapies and determine if they are effective and a means of improving patient satisfaction with sleep.
Dubenske, L.L., Gustafson, D.H., Namkoong, K., Hawkins, R.P., Atwood, A.K., Brown, R.L., . . . Cleary, J.F. (2014). CHESS improves cancer caregivers' burden and mood: Results of an eHealth RCT. Health Psychology, 33, 1261–1272
To compare the effects of Comprehensive Health Enhancement Support System (CHESS) access intervention versus provision of internet with recommended websites for lung care cancer care on informal caregivers’ burden, disruptiveness, and mood
Patients and their caregivers were provided with laptops with internet that allowed access to CHESS. CHESS is a home-based e-health system that helps users to appraise the controllability of cancer-related stressors and improves their cognitive, behavioral, and supportive coping skills by providing them with a variety of information, communication, and coaching services appropriate for cancer caregivers based on their need and preference. CHESS allows sharing critical information with clinicians via Clinician Report, where caregivers are able to communicate their needs, ask questions, and rate patients’ symptoms on a scale of 0–10. A score of 7 or more triggers an email alert to the patient’s treating clinician so he or she is aware of the patient’s and caregiver’s situation on the next patient visit. Patients randomly were assigned to internet use only or CHESS plus internet use. Internet users were provided with internet access and a list of high-quality websites for information.
Average use of CHESS among the intervention group was 14.6 logins, averaging browsing 293 pages and spending 177 minutes on the system (almost 50 minutes monthly). Statistically significant improvement was seen in the intervention group over the control group at six months follow-up in burden (p = .02) and negative mood (p = .006), but not in disruptiveness. These effects persisted even when patient symptom distress (on the ESAS) and other covariates were controlled. Analyses also show that these significant differences existed only at six-month follow-up, not at any other times.
Targeted electronic systems that are designed comprehensively to help caregivers can improve their experience of caregiving by minimizing their perceived burden and improving their mood.
Targeted e-health systems are more likely to be beneficial to caregivers of patients with cancer when they are self-directed and have a comprehensive approach to caregivers’ needs (e.g., information, communication, coaching, interaction with healthcare providers). The benefits of e-health vary among cancer caregivers and depend on how they use the tools offered by such systems. Which feature or combination of features would be most helpful to this group of caregivers remains to be determined.
Du, S., Hu, L., Dong, J., Xu, G., Jin, S., Zhang, H., & Yin, H. (2015). Patient education programs for cancer-related fatigue: A systematic review. Patient Education and Counseling, 98, 1308–1319.
Interventions included exercise in eight studies, sleep hygiene in seven, relaxation training in six, and nutritional guidance in six. Six studies included the use of a booklet as supplement material. Four studies included telephone follow-up, and one was provided via an Internet-based program. The program duration ranged from 1 week to 12 weeks. Attrition rates ranged from 7%–46.7%. Two studies demonstrated significant reduction of fatigue with ES ranging from –0.76 to –1.41 (p < 0.001). Six studies concluded achieving a limited positive effect, with a small effect size and no statistical significance. One study showed no effect, and one showed worse outcomes in the intervention group. High heterogeneity existed across trials, so no meta-analysis was deemed appropriate.
Inconsistent evidence of effects of patient education programs on cancer-related fatigue existed across all 10 studies.
Some mixed evidence exists regarding the effects of patient education programs on cancer-related fatigue, which are related to the variability in interventions that have been studied. More rigorous research is needed to sort out those program characteristics and populations of patients who can benefit most from educational interventions.
Dranitsaris, G., Mazzarello, S., Smith, S., Vandermeer, L., Bouganim, N., & Clemons, M. (2016). Measuring the impact of guideline-based antiemetic therapy on nausea and vomiting control in breast cancer patients with multiple risk factors. Supportive Care in Cancer, 24, 1563–1569.
The purpose of this study was to determine if guideline-based antiemetic therapy would improve chemotherapy-induced nausea and vomiting (CINV) in patients with multiple risk factors for CINV
Patients from all risk levels had similar rates of acute and delayed vomiting; however, acute and delayed nausea remained higher in the high-risk patients.
By assessing patient risk factors for CINV and prescribing antiemetic therapy based on patient risk stratification, acute and delayed vomiting may be managed; however, acute and delayed nausea remained significantly higher in the highest risk patients.
Drake, R.D., Lin, W.M., King, M., Farrar, D., Miller, D.S., & Coleman, R.L. (2004). Oral dexamethasone attenuates Doxil®-induced palmar-plantar erythrodysesthesias in patients with recurrent gynecologic malignancies. Gynecologic Oncology, 94, 320–324.
To evaluate the effectiveness of oral dexamethasone in attenuating or eliminating palmar-plantar erythrodysesthesias (PPE) induced by pegylated liposomal doxorubicin (PLD) (Doxil®) in patients with recurrent gynecologic malignancies.
Patients were initially treated with PLD without dexamethasone (median number of cycles = 5). Patients who experienced grade 2 to 4 PPE had treatment delayed until symptom resolution, and then were retreated without dose reduction.
Patients in group 1 received a tapering oral dexamethasone regimen (8 mg BID) starting one day before infusion for five days, 4 mg BID on day 6, and 4 mg on day 7.
In group 2, patients who were not receiving dexamethasone and experienced grade 2 to 4 PPE had a weekly dose delay for up to two weeks until symptom resolution. If resolution occurred within three weeks of the delay, a 25% dose reduction was made. Patients who had persistent grade 3 or 4 PPE had PLD withdrawn.
University of Texas Southwestern Medical Center in Dallas
This was a prospective, observational trial.
National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) was used to assess PPE (grades 1–4).
Oral dexamethasone appears to be effective in attenuating or eliminating PLD-induced PPE in patients with recurrent gynecologic malignancies.
The sample size was small.
Do, T., Medhekar, R., Bhat, R., Chen, H., Niravath, P., & Trivedi, M.V. (2015). The risk of febrile neutropenia and need for G-CSF primary prophylaxis with the docetaxel and cyclophosphamide regimen in early-stage breast cancer patients: A meta-analysis. Breast Cancer Research and Treatment, 153, 591–597.
PHASE OF CARE: Active antitumor treatment
883 patients across studies did not receive G-CSFs, of which 21.97% developed FN (adjusted rate 23.2%). Compared to patients who did not receive G-CSFs, patients who received G-CSFs had an OR of 0.077 (95% CI [0.013, 0.460]), a 92.3% lower incidence rate. Patients younger than age 65 also had a lower rate of FN (4.2%–66.7%) compared to patients 65 and older (7.7%–88.2%).
Use of G-CSFpp significantly reduces the risk of FN in patients with early-stage breast cancer receiving TC therapy. Patients younger than age 65 also have a reduced risk of FN compared to patients 65 years and older.
The reporting of findings differed between use of G-CSF (OR) and no use (%). They did report a 93% lower risk with use of G-CSF. The reporting of age differences did not differentiate between use or no use of G-CSF.
Aside from the limitations noted above, use of G-CSF as primary prophylaxis reduces the risk of FN in this patient population. Oncology nurses should be aware of the risks of FN in patients being treated with TC for early-stage breast cancer and promote use of G-CSFpp.
Doss, J.J.K. (2014). Effectiveness of foot massage on level of pain among patients with cancer. Asian Journal of Nursing Education and Research, 4, 228–231.
To evaluate the effectiveness of foot massage on pain in patients with cancer
This research was a nonrandomized, two-group, quasi-experimental time series design conducted among 60 patients with cancer. The experimental group received a 30-minute foot massage over a three-day period. Pain was assessed using the Numeric Rating Scale for pain, which used a 0–10 range. Pain was assessed prior to the intervention and after the intervention for three days.
Nonrandomized, two-group, quasi-experimental, time series trail
On day 1, all patients in both groups reported severe pain. On day 2, most of the patients reported moderate pain with no measurable differences between the two groups. On day 3, the experimental group reported mild to no pain, and there was no change in the control group from day 2. The intervention group experienced a significant reduction in pain (p < 0.001).
This study shows the need to understand the purpose of foot massage techniques on pain levels in patients with cancer. The researcher assumed that with a decrease in pain, there would be an increase in patients' quality of life including stability in physiologic, psychological, sexual, vocational, and lifestyle aspects. These areas were not measured, and additional research is needed.
Foot massage is an easy and cost-effective nursing intervention that could be used to help ease patient pain. This research article identified the need to continue research in this area. The patient parameters need to be more specific in future research designs.
dos Santos, L.V., Souza, F.H., Brunetto, A.T., Sasse, A.D., & da Silveira Nogueira Lima, J.P. (2012). Neurokinin-1 receptor antagonists for chemotherapy-induced nausea and vomiting: A systematic review. Journal of the National Cancer Institute, 104(17), 1280–1292.
To evaluate the overall effectiveness and safety of neurokinin 1 (NK1) receptor antagonists (RAs) in the prevention of chemotherapy-induced nausea and vomiting (CINV) when compared to standard antiemetic regimens including a 5-HT3 RA plus dexamethasone
Databases searched were MEDLINE, Embase, Cochrane Central Register of Controlled Trials (Central), and Latin American and Carribean Health Sciences Literature (LILACS).
Search keywords were neurokinin, aprepitant, casopitant, ezlopitant, netupitant, vestipitant, chemotherapy-induced nausea and vomiting, nausea in cancer patients, vomiting in cancer patients, and randomized trials.
Studies were included in the review if they
No specific exclusion criteria were identified.
A total of 4,034 references were retrieved.
Two reviewers assessed the quality of each study. Items from Delphi list and Jadad score were utilized for data extraction; however, the authors did not describe if any specific scoring system was used for quality assessment.
All patients were in active antitumor treatment.
The addition of an NK1 RA increased CINV control in the acute, delayed, and overall phases.
The use of an NK1 RA may be associated with a statistically significant increase in the risk of severe infection. A more comprehensive evaluation of the safety profile of NK1 RAs and additional appraisal of specific data from RCTs is needed.