To evaluate effectiveness of a memory training intervention as compared to a health training group intervention for management of cognitive impairment in older adult cancer survivors

Measures were performed pre-intervention, post-intervention, post-booster intervention, and six months afterwards. The memory training intervention consisted of eight sessions incorporating 20 minutes of relaxation, a targeted memory topic, and 30 minutes of targeted practice with role model. Participants received a memory improvement book at end of the memory intervention. The health training consisted of providing 18 health-related topics over two months; the frequency of the training was not provided. Booster sessions consisted of four weekly mandatory two-hour sessions over one month conducted within three months after completion of initial training. 

• A total of 22 patients participated in the study. Eight received the memory intervention, and 14 received health training.
• Participants' mean age was 73.8 years(SD = 4.82 years).
• The sample was 41% male and 59% female.
• Participants had been diagnosed with breast cancer (n = 8), prostate cancer (n = 5), facial or nose basal cell carcinoma (n = 3), uterine cancer (n = 2), leukemia/lymphoma (n = 2), throat cancer (n = 1), or lung cancer (n = 1).
• 86% of the sample was Caucasian.
• On average, participants had completed 16 years of education.
• Socioeconomic status varied among the sample.
• The length of time from oncology treatment was unknown.

• Mutli-site
• Outpatient setting
• Austin, TX

• Patients were undergoing long-term follow-up.
• The study has clinical applicability for older adult care.

Randomized clinical trial

• Hopkins Verbal Learning Test–Revised (HVLT-R)     
• Brief Visuospatial Memory Test–Revised (BVMT-R)
• Rivermead Everyday Behavioural Memory Test (REBMT)
• Metamemory in Adulthood QuestionnaireDirect Assessment of Functional Status
• Memory Self-Efficacy Questionnaire
• Mini-Mental Status Examination

Visual memory as measured by the BVMT-R was improved (p < 0.1 for the group by time interaction) for participants who received the memory training intervention. Trends toward improvement in verbal memory as measured by the HVLT-R and overall memory as measured on the standardized profile scale of the REBMT were observed for participants who received the memory intervention, but they were not significant. Improvements were seen in self-reported memory components in locus, capacity, and control (p < 0.05 for the group by time interaction) and use of internal strategies (p < 0.1 for time). Memory complaints decreased (p < 0.05 for the group by time interaction). 

Significant improvements in visual memory were obtained and sustained, and trends for improving verbal and global memory were observed in those who participated in the memory training. In addition, those who participated in memory training maintained their use of internal compensatory strategies and reported significant improvements in subjective aspects of cognitive function, including increased confidence, greater capacity, belief that they could better manage issues with their memory, and decreased complaints of their memory performance.

• The sample was small at less than 30 participants.
• The generalizability of the results was limited.
• The feasibility of replicating the memory training intervention was limited.

Cognitive impairments present ongoing symptom management issues for older adult cancer survivors. Memory training has been effective in older individuals and may offer opportunities for improvements in memory difficulties for older adult cancer survivors. The authors suggested that their memory training intervention may be adjusted to meet the specific cognitive issues that older cancer survivors report. Further studies are needed to determine feasibility and generalizability to patients with cancer.

The study was conducted to determine the effect of a rehabilitative intervention on cognitive function, depression, and functioning.

The study framework included two intervention groups and one wait-list control group. Participants were randomized into intervention group 1 (receiving eight classes and a memory book) or the wait-list control group (Group 3). Wait-list control group participants were further randomized into intervention group 2 (receiving only the memory book) or group 3.

Intervention group 1 received a memory book and classes on day 1; intervention group 2 received a memory book on day 1 and began classes four weeks later. Wait-list control group participants received a memory book on day 1. Participants from intervention group 2 and the wait-list control group were placed in classes together based on location. All classes were identical.

• The total number of participants was 78.
• The average partcipant age was 82.
• There were 58 women and 20 men in the study. 
• Participants were divided into four groups of chronic conditions for analysis: arthritis (n = 16), cancer (n = 11), heart disease (n = 32), and other (n = 19).
• On average, participants had attained 15 years of education. 

The study took place at a comprehensive retirement community in the Midwest that included independent and assisted-living dwellers.

The study utilized a randomized, controlled trial.

• Mini-Mental State Examination (MMSE) for global cognitive functioning
• Geriatric Depression Scale for depression
• Instrumental Activities of Daily Living Scale (IADL) for functional ability
• Multi-Level Assessment Instrument (MAI) as a health subscale
• Rivermead Behavioral Memory Test (RBMT)
• The Metamemory in Adulthood Questionnaire (MIA) was utilized. This 108-item assessment tool has 7 subscales assessing strategy, task, capacity, change, anxiety, achievement, and locus.

Cancer survivors showed significant improvements after the intervention in

• Memory efficacy (p = 0.05)
• Metamemory change (p = 0.0001)
• RBMT Immediate Story Recall (p = 0.006)
• RBMT Delayed Story Recall (p = 0.002)
• RBMT Belonging (p = 0.05).

The cancer survivors scored higher on managing finances (p = 0.01). They had lower total IADL scores compared with the control group, and scored lower on baseline metamemory capacity, with an average score of 2.5 (p = 0.03). They showed worsening after the intervention on the RBMT Immediate Route test (p = 0.03) and the RBMT Delayed Route test (p = 0.0001). The cancer survivors were older, with an average age of 84.12 years (p = 0.02). 

Significant associations were observed for the total sample between 

• IADL scores and memory performance on the RBMT (r = -0.44, p < 0.05)
• IADL scores and metamemory subscale of change (r = -0.33, p < 0.05)
• IADL scores and external memory strategy (r = -0.29, p < 0.05)
• Depression and memory performance on the RBMT (r = -0.31, p < 0.05).

There were no significant pre-test differences between groups on memory performance, memory self-efficacy scores, or MMSE scores. The total sample had a relatively high perception of health status and a low incidence of depression (13%). 

Post-intervention tests showed no improvements in objective memory performance, despite reported improvements in subjective memory and memory self-efficacy.

• This was not a cancer-specific study and had only a small sample of cancer survivors.
• Cancer diagnoses were not reported, and no information regarding cancer-related treatments was provided.
• Participants were assigned to the chronic illness categories by the researchers.
• No listing was provided of the medications taken between groups, which could affect cognitive performance.
• It was reported that many participants began practicing mental activities and exercises prior to the intervention's initiation, potentially affecting baseline scores for cognitive performance.
• A documentation of when the post-test was performed was not found.

To report the effect of an early palliative care intervention on quality of life (QOL) and satisfaction with care of caregivers of patients with advanced cancer

A cluster randomization process involving patients and their caregivers in 24 Canadian medical oncology clinics supported two randomized arms: an intervention with early palliative care team referral or usual oncology care with palliative care only as needed. Further stratification of clinics by tumor site supported the two study arms. Both arms included caregivers of patients with advanced cancer, defined as having a clinical prognosis of 6–24 months and an ECOG score of 0–2, who completed previously validated instruments on care satisfaction (FAMCARE-19) and QOL (SF-36v2 Health Survey, Caregiver Quality of Life Index-Cancer [CQOL-C]). A mixed effect model evaluated intervention group improvement over the control group at baseline assessment and monthly for as many as four months.

• N = 182, 94 in intervention and 88 in control
• MEDIAN AGE = 58 years (intervention), 57 years (control) 
• MALES: 35% (not specifically stated, extrapolated from female percentage), FEMALES: 65% 
• CURRENT TREATMENT: Not specified
• KEY DISEASE CHARACTERISTICS: Stage III with poor prognosis or stage IV disease (hormone refractory disease of breast and prostate cancer); cancer diagnoses included lung, gastrointestinal, genitourinary, breast, and gynecologic.
• OTHER KEY SAMPLE CHARACTERISTICS: Patients with an ECOG status of 0–2 and who passed a cognitive screening (Short Orientation-Memory-Concentration Test, greater than 20 or less than 10 errors)

• SITE: Palliative care clinic
• SETTING TYPE: Outpatient oncology clinics
• LOCATION: Princess Margaret Cancer Centre, Toronto, Canada

• PHASE OF CARE: Advanced cancer diagnosis (prognosis of 6–24 months)
• APPLICATIONS: Palliative care

Cluster randomized trial design

• Satisfaction in care: 19-item FAMCARE Scale (FAMCARE-19) 
• QOL measurements: SF-36v2 Health Survey, CQOL-C

Canadian caregivers of patients with advanced cancer that receive early palliative care team intervention experience increased satisfaction with care compared to those who receive standard oncology care. Additional work to explore the impact of an early palliative care team intervention on caregiver QOL with an attention on factors like sample size and contextual factors of care will contribute to the science in this area.

• Risk of bias (no blinding) (no full blinding due to cluster design
• Risk of bias (sample characteristics)
• Measurement/methods not well described
• Subject withdrawals ≥ 10%  (17% attrition after baseline assessment)
• Recruitment from a single cancer center
• The intervention was complex, and no measurement of dosage of ancillary interventions, which included qualitative interviews, was included.

Few clinical trials assess the effect of early palliative care interventions on caregivers of patients with advanced cancer. Current standards of care for patients with advanced cancer include integrating palliative care to improve patient care satisfaction and QOL. This study shows evidence that including those patient caregivers in such an approach improves their satisfaction with care, although it is unclear whether it improves their overall QOL.

• FINAL NUMBER STUDIES INCLUDED = 26
• TOTAL PATIENTS INCLUDED IN REVIEW = Not stated
• KEY SAMPLE CHARACTERISTICS: Adults at risk for nausea related to chemotherapy or radiotherapy

PHASE OF CARE: Active antitumor treatment

The strongest evidence suggested that three-drug regimens (5HT3 antagonists plus corticosteroids and aprepitant) with mixed delivery methods (PO plus IV) offered maximal relief of chemotherapy-induced nausea and vomiting (CINV).

• The evidence combined patients receiving chemotherapy and radiotherapy, so the results may not be completely applicable to CINV.
• Many of the studies included in this review had a low strength of evidence in the AHRQ grading system.

The addition of aprepitant to standard antiemetic regimens with mixed PO and IV antiemetics can greatly improve CINV in patients with cancer.

To determine the effect of a standardized nursing intervention on protocol (SNIP) on newly diagnosed men and their female spouses on marital interaction, sexual function, and depressive symptoms following radical prostatectomy over a six-month period

Couples were randomly assigned to an intervention (SNIP) or a usual care group. The usual care group received care according to standards identified by the urology clinic group, and the SNIP group dyads received 16 contacts (twice per week: home visit and telephone call) from an advanced practice nurse (APN) specially trained for the study to deliver an evidence-based protocol. Dyad conversations with APNs evolved from reading of a common public education booklet given to couples during the SNIP intervention. Measurement of outcome variables (depression, marital interaction, and sexual function) occurred in both the usual and intervention groups at baseline and one, three, and six months following radical prostatectomy.

• The sample was comprised of 107 patient–spouse pairs (54 in the SNIP group; 53 in the usual care group).
• Of the sample spouses, 82.3% were age 45–64 years; of the patients, 77.6% were age 45–64 years.
• Spouses were female (100%).
• Patients all had a radical prostatectomy due to cancer; spouses had one to three comorbidities, although further specifics about the type of morbidities do not appear in the article.
• Spouses were predominantly white (85.1%), married to the patient (93.5%), had some college education (63.6%), and were employed (57%).
• Patient and spousal income placed couples in middle to upper socioeconomic class (annual income greater than $50,000).
• Couples lived within 50 miles of the study centers.

• Two academic medical centers
• Northeastern United States

The study design was secondary data analysis of a prospective, randomized clinical trial with repeated measures.

• Center for Epidemiological Studies–Depression Scale (CES-D)
• Center Rehabilitation Evaluation System (CARES): 26 items are representative of two of five subscales that assessed sexual interest/dysfunction and marital interaction. Reliability of the two subscales ranged from 0.66 to 0.85 across measurements collected at one, three, and six months of the study.

Analysis of variance procedures indicated that among patients, outcome measures showed no indication of main effects due to group assignment. However, spouses had significant differences for some of the measures at six months, with the SNIP group spouses having higher depression scores that approached significance. The SNIP spouses also had a higher average sexual function distress score and a significantly higher marital interaction distress score than did the control group spouses. Spouses reported significantly higher levels of depressive symptoms and more marital interaction distress as compared to patients. However, patients reported significantly more sexual function distress than did their spouses. The SNIP intervention had no group effect on depressive symptoms, but such symptoms improved over time in both patients and spouses. The SNIP intervention showed a modest effect on patients’ sexual function and marital interaction over time, with SNIP patients and spouses reporting increased distress. However, control group women reported significantly lower rates of sexual functioning distress over time compared to the SNIP group. Pearson correlations showed patient depressive symptoms related to patient marital interaction, spousal depressive symptoms, and spousal marital interactions.

An intervention such as SNIP can effectively address depressive symptoms of newly diagnosed patients with prostatectomy and their spouses, as well as relevant issues such as patient sexual function and marital interaction that change with radical prostatectomy. A trained nurse, delivering an evidence-based intervention focused on the needs of these dyads, can assist them in understanding expected postsurgical changes and implementing actions to foster hope and recovery within the dyad.

• The study had a limited non-white sample.
• The study had a small sample size to exert sufficient power to identity significant changes between the SNIP group and the usual care group.

Nurses should routinely assess depressive symptoms of patients and their primary support system to define needed interventions during cancer treatment. Patient and spouse (caregiver) teaching about common side effects of cancer treatment, ways of responding to those side effects, and the potential for recovery of earlier functions should be included at each patient encounter. Support groups for both patients and caregivers may further bolster networking with others who have “moved beyond” the early consequences of prostate surgery and offer hope to recent surgical patients and their spouses. An evidence-based intervention delivered by APNs, such as the one used in this study, offers structure and process of care to promote quality care of those individuals.

To determine effect of completion of a recovery program including gentle exercise and deep breathing on breast cancer-related lymphedma

Patients assigned to the treatment group attended biweekly one-hour exercise and educational sessions for five weeks, then followed a three-month self-monitored home program. Those in the treatment group were instructed to complete use of a video and relaxation daily at home. Exercises included gravity-resistive arm movements incorporating shoulder flexion, abduction, and external rotation. Exercise and compression hose adherence was assessed with a self-report tool designed for the study. Control patients received usual care. Patients were assigned into four groups of treatment and controls.

The study sample (N = 32) was comprised of female patients aged 21–80 years with stage I or II unilateral breast cancer-related lymphedema.

The study took place in an outpatient site in Pittsburgh, PA.

The study used a randomized controlled single blind trial design.

• Bioimpedance differences were compared between the affected and unaffected arm.
• The Beck Depression Inventory measured severity of depression.
• The 36-Item Short Form Health Survey (SF-36) measured quality of life.
• Cone girth was measured.

Bioimpedance mean differences of those in treatment compared with controls showed a positive main effect for treatment (p = 0.049). There was no significant effect on volume measures. Patients who complied with compression demonstrated improvement over time. Range of motion, mood, and quality of life improved in those in the treatment group.

The program of combined exercise activity and self-directed practice related to coping and relaxation were associated with improvement in lymphedema and other symptoms.

• The sample size was small (N < 100).
• The study had no attentional control.
• Limited information is provided regarding all aspects of the intervention.
• Lack of participant binding poses potential for patient self-report measures.

Findings support the positive benefit of patient upper-extremity exercises in the management of lymphedema.

GM-CSF 2 mcg/kg (-1) (150 mcg) daily for 14 days starting on day 14 of a 21-day course of RT.

Note: Placebo injections were not given; observer was blinded to treatment.

The study was comprised of 29 patients (GM-CSF = 14).

Power analysis was completed, but not met (n = 17 in each group).

Patients with proven T1 N0 or T2 N0 glottic carcinoma were being treated with radiotherapy using a 16 fraction 3-week regimen.

Required to have a WHO performance status of grade 0 or higher, no renal or hepatic issues, serious infections requiring antibiotics, or likely need for corticosteroids.
 

Prospective, randomized, observer blind phase II trial

• RTOG
• Skin erythema
• Moist and dry desquamation
• Pain on swallowing
• Severity of dysphagia
• Analgesic usage
• Evidence of candida infection and laryngeal edema
• Patients weights before and after treatment
   

Significant difference in the incidence of mucositis p < 0.05, mean time of healing improved but not significant p = 0.25.
No differences in dysphagia, odynophagia, analgesic use, candida infection, of laryngeal edema.
 

• Study sample size was very small.
• Only used for early treatment of laryngeal cancer with radiotherapy using 16 fraction 3-week regimen.
• Frequent side effects related to GMCSF
• No large trials have been conducted.
   

Subcutaneous (SC) morphine 5 mg or placebo in opioid-naïve patients and regular oral morphine dose plus half of the every-four-hour (q4h) dose given SC in patients on regularly scheduled opioids

• The sample was comprised of nine patients (seven opioid naïve and two opioid tolerant).
• Mean patient age was 73 years.
• The sample included four women with advanced cancer and dyspnea resulting from lung involvement.
• All patients had normal Mini-Mental Status Examinations (MMSEs).

The study was conducted in an inpatient geriatric hospital.

The study was a double-blind, placebo controlled, randomized, cross-over trial.

• Dyspnea visual analogue scale (VAS) (100 mm) and Borg scale obtained at baseline and 45 minutes after SC study dose and repeated until 240 minutes
• VAS for pain, somnolence, and anxiety
• Respiratory effort, including rate, cyanosis, and use of accessory muscles
• Pulse oximetry

• Mean change of VAS (–25, p < 0.01) and Borg scale (–1.20, p = 0.03) scores were significantly decreased with morphine compared to placebo.
• Respiratory effort (p = 0.05) and rate (p = 0.02) scores were significantly improved after morphine compared to placebo.
• No significant changes in pain, somnolence, anxiety, or oxygen percent saturation were found.

Intermittent injections of morphine at the doses used reduce cancer-related dyspnea. The changes in respiratory effort and rate but not anxiety support the theory that the benefit of morphine is unlikely related to somnolence or an effect on anxiety.

• This is a well-designed randomized, controlled study with the major limitation of sample size.
• The study points out the difficulty in conducting pharmacologic studies in patients with cancer and dyspnea.

To describe differences in bowel function with oral or IV opioids.

Patients who were admitted to a palliative inpatient unit for pain management had data retrospectively collected related to morphine-induced constipation. After IV morphine was administered and dose requirements were determined, patients were converted to oral morphine and then discharged.

• The study reported on a sample of 11 patients with cancer.
• Mean patient age was 43 years.
• The sample comprised eight men and three women.
• Patients were included in the study if they were admitted to a palliative care unit for IV morphine.
• Patients were excluded if they had gastrointestinal malignancy or disorders.

• Single site
• Inpatient
• India

The study has clinical applicability to end-of-life and palliative care.

This was a retrospective, descriptive study.

Visual analog scale

• Patients on IV morphine did not require laxatives for bowel movements to occur.
• Of patients switched to oral morphine, seven of 11 needed laxatives during their inpatient stay and were discharged with laxative prescriptions.

Patients on IV morphine were less likely to need laxative therapy to promote bowel function compared with patients on oral morphine. All patients on oral morphine needed laxative therapy.

• The sample size was extremely small.
• The design was retrospective and descriptive only.

Implications are limited because of the small sample size and other uncontrolled variables. More research is needed to determine whether IV morphine is less constipating than oral morphine and the applicability of this information in patient care.

To determine if massage therapy was effective relief for chemotherapy-induced nausea and vomiting (CINV) in children with cancer

Patients in the intervention group received a 20 minute massage 24 hours and 30 minutes before a chemotherapy infusion and 24 hours postinfusion. A trained massage therapist used a Swedish massage technique with effleurage, petrissage, friction, and tapping movements. Mild to moderate pressure was used. Subjects were randomized by a randomized number table. Patients could elect to use olive oil with the massage. No music was used during the therapy. The control group received normal care, but the therapist was present 24 hours and 30 minutes before an infusion as well as 24 hours postinfusion. Data were collected during chemotherapy and 48 hours postinfusion.

• N = 70  
• MEAN AGE = 8.6 years
• MALES: 52%, FEMALES: 48%
• KEY DISEASE CHARACTERISTICS: Majority of patients had acute lymphocytic leukemia 
• OTHER KEY SAMPLE CHARACTERISTICS: Pediatrics, ages 4–18 years

• SITE: Single-site  
• SETTING TYPE: Outpatient    
• LOCATION: Iran

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Randomized, controlled trial

• Baxter Animated Retching Faces (BARF) scale (ages 4–9)
• Visual Analog Scale (VAS) (ages 9–18)

There were no significant differences between the intervention and the control group in terms of gender, type of cancer, or emetic potential of chemotherapy. There was no difference between groups in regard to nausea during chemotherapy. There was a significant difference in frequency (p = 0.001), duration (p = 0.002), and severity (p = 0.002) of nausea 48 hours after chemotherapy. There was no difference in vomiting at the time of chemotherapy, but there was a significant difference in the severity (p = 0.005) and frequency (p = 0.013) of vomiting 48 hours postinfusion.

Massage therapy may effectively decrease nausea and vomiting 48 hours after chemotherapy infusion in children.

• Small sample (< 100)
• Risk of bias (no blinding)
• Other limitations/explanation: Two different measurement instruments were used depending on the age of the child in the study.

Massage therapy, administered both before and after a chemotherapy infusion, may be effective in limiting CINV in the pediatric population. Massage was not effective at relieving anticipatory CINV that occurred at the time of infusion.