Nejad, Z.K., Aghdam, A.M., Hassankhani, H., & Sanaat, Z. (2016). The effects of a patient-caregiver education and follow-up program on the breast cancer caregiver strain index. Iranian Red Crescent Medical Journal, 18(3), e21627.
To assess the benefit of an intervention of two face-to-face education sessions at the bedside and four interventions for patients with breast cancer and their caregivers
Sixty patients with breast cancer and their caregivers (60 pairs) were randomized to either the usual care group or the intervention group. Both groups received a comprehensive medication review and education after the pretest. The intervention group received two face-to-face education sessions reviewing a booklet that discussed patient needs; informational needs, such as nutrition, medication, rest, and activity; and chemotherapy side effect management, as well as four telephone calls assessing educational needs, followed by a post-test three weeks later.
The mean caregiver strain score of the intervention dropped from 8.3 (SD = 2) to 2.3 after the intervention. The paired t-test results indicated that both the intervention and control groups were statistically different after the intervention in terms of caregiver strain scores (p < 0.001).
The caregiver group that received the intervention showed a statistical improvement in the pretest/post-test caregiver scores. The results showed an impressive improvement in the reduction of caregiver strain.
The authors described a benefit from an oncology nurse-focused intervention to decrease caregiver strain and burden. This intervention lacked specificity. Further areas of exploration should be depression, anxiety, and future use of additional tools to assess the effectiveness. Future studies should obtain larger sample sizes.
Neary, N.M., Small, C.J., Wren, A.M., Lee, J.L., Druce, M.R., Palmieri, C., . . . Bloom, S.R. (2004). Ghrelin increases energy intake in cancer patients with impaired appetite: Acute, randomized, placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism, 89, 2832–2836.
To determine whether ghrelin stimulates appetite in patients with cancer who have anorexia. Ghrelin is an appetite-stimulating hormone.
Patients received ghrelin (5 pmol/kg/min) or saline; four patients received ghrelin then saline (n = 4) or saline followed by ghrelin (n = 3).
Patients were recruited from oncology clinics at Charing Cross Hospital (United Kingdom).
The study was a prospective, randomized, placebo-controlled, crossover clinical trial.
Energy intake from a buffet meal during saline or ghrelin infusion indicated there was a 31% increase in energy intake in patients during the ghrelin infusion, and greater meal appreciation (by 28 +/- 8%). No side effects of the ghrelin therapy were observed. No changes were reported in levels of insulin, glucose, or triglycerides. Patients recorded greater food consumption on the days they received the ghrelin.
Further investigations are needed before conclusions can be drawn.
National Comprehensive Cancer Network. (2015). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Adult cancer pain [v.2.2015]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf
The results of literature search were not provided, and the only database cited was PubMed.
These guidelines provided dosing recommendations for the use of nonsteroidal anti-inflammatory drugs, opioids, etc. for various levels of pain. It recommended many types of adjuvant pharmacologic and nonharmacologic interventions, from energy conservation to cognitive behavioral therapy. It specifically suggested opioids for breakthrough pain at a standard percentage of basal opioid dose, education, and anxiolytics for acute pain.
Many of the guidelines were based on consensus and did not provide specific information about the evidence for each recommendation. The scope of the guideline was holistic in nature but less clear in terms of the actual evidence base
These guidelines provided useful information about dosing, equivalents across multiple medication types, and strategies for opioid rotation but did not provide clarity in terms of the actual strength of recommendations based on evidence.
National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology: Myeloid growth factors [V.2.2016]. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf
RESOURCE TYPE: Consensus-based guideline
PHASE OF CARE: Active antitumor treatment
Limited database to PubMed, no full evidence evaluation provided. Although they suggest prophylaxis based on a percentage risk and suggest chemotherapy dosages accordingly, it does not match current practice in which dosages and regimens may not always be standard, causing a lack of clarity for clinical implementation of these standards.
Both chemotherapy regimens as well as patient-specific risk factors need to be considered to determine patients’ level of risk for developing FN. CSFs have been shown to reduce the incidence of FN and some infection events; however, evidence suggests that relevant guidelines and recommendations regarding the use of CSFs are not routinely followed in clinical practice. Nurses can advocate for adherence to CSF prophylaxis in at-risk patients.
National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines in Oncology: Myeloid growth factors [v.1.2012].
The purpose of this article is to provide guidance regarding the use of myeloid growth factors for adult patients with cancer. The study focused on chemotherapy-induced neutropenia.
Consensus-based guideline
Not applicable or stated
Recommends prophylactic use of colony-stimulating factors (CSFs) in patients with 20% risk of febrile neutropenia, consideration of CSFs with 10%–20% risk, and no CSF for less than 10% risk.
Suggests consideration of secondary prophylaxis in cases of prior febrile neutropenia or dose-limiting neutropenic event.
Recommends continuation of CSFs during chemotherapy cycle in the setting of febrile neutropenia for those on prophylactic CSF, and consideration of initiating CSFs in patients with risk factors for infection-associated complication.
Provides extensive listing of factors indicating, 20%, 10%–20% risks. Provides information on toxicity risks with growth factors as well as dose and timing recommendations.
Most recommendations are based on low level of evidence and consensus.
Provides expert opinion and consensus-based recommendations regarding the use of CSFs in patients undergoing chemotherapy for cancer.
National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections [v. 2.2016]. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf
PURPOSE: To provide guidance for the clinical practice of preventing and treating infection in patients with cancer
PHASE OF CARE: Multiple phases of care
One thousand one hundred sixty-two publications were retrieved. No method of study quality evaluation or results were reported.
The combination of evidence- and consensus-based recommendations and the differentiation between them are not clearly stated. For vascular access device prevention of infection, the guidelines only address antimicrobial-coated catheters and not any other aspect of management.
The guidelines provide a comprehensive reference to assess patient risk of infection and expert recommendations regarding interventions aimed at the prevention and treatment of infection in patients with cancer. They do not discuss long-term survivorship issues in this area.
National Comprehensive Cancer Network. (2011). NCCN Clinical Practice Guidelines in Oncology: Prevention and treatment of cancer-related infections [v.2.2011]. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf
To provide guidance for clinical practices for the prevention and treatment of infection in patients with cancer.
This resource is a consensus-based guideline.
Patients were undergoing the active antitumor treatment phase of care.
The guideline
The National Comprehensive Cancer Network (NCCN) does not currently endorse the use of a vancomycin lock solution for long-term vascular access devices due to concerns about the emergence of bacterial resistance if widely used. Influenza vaccination with a vaccine that does not use live attenuated organisms can be safely given, and the guideline recommends administration at least two weeks before receiving cytotoxic therapy.
This study lacked high-quality evidence, with most recommendations being based on consensus.
This guideline provided comprehensive references to assess patient risk of infection and expert recommendations regarding interventions aimed at the prevention and treatment of infection in patients with cancer. The guideline does not discuss long-term survivorship issues in this area.
National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology: Cancer-related fatigue [v.1.2016]. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf
PHASE OF CARE: Multiple phases of care
Two hundred two references were retrieved. The total number of references included and reviewed for updating was not provided. No quality rating is identified.
The guidelines provide suggestions for screening and identify some tools for fatigue assessment and some key interventions for the management of fatigue. They provide an overview of relevant evidence for multiple types of interventions. Major suggestions are identified in the recommendations section of this summary.
National Comprehensive Cancer Network. (2015). NCCN Clinical Practice Guidelines in Oncology: Antiemesis [v.2.2015]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf
PURPOSE: To provide recommendations for antiemesis in patients with cancer
RESOURCE TYPE: Consensus-based guideline
PHASE OF CARE: Active antitumor treatment
No detailed information about literature searching or evidence grading was provided, and most recommendations were based on low-level evidence and consensus. A panel developed the recommendations.
This guideline provides a good resource for identifying the emetogenicity of various oral and IV chemotherapy agents, and it provides recommendations for radiation-related nausea and vomiting. The guideline is limited in that the full evidence base for all adjuvant recommendations is not provided, and the full strategy for the search and review of evidence is not stated.
National Comprehensive Cancer Network. (2015). NCCN Clinical Practice Guidelines in Oncology: Distress management [v.3.2015]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf
PHASE OF CARE: Multiple phases of care
242 references were retrieved. No specific rating of study quality is described and most evidence is at the level of consensus.
For anxiety and depression, psychotherapy with or without psychotropic drugs is recommended. Social service and chaplain counseling are suggested. Specific algorithms for chaplain interventions are provided.
Most recommendations are consensus-based. Limited search database
Suggestions for management of distress, and guidelines for the use of the NCCN Distress Thermometer and for distress screening are provided.