Chan, C.W., Lam, L.W., Li, C.K., Cheung, J.S., Cheng, K.K., Chik, K.W., . . . Tang, W.P. (2015). Feasibility of psychoeducational interventions in managing chemotherapy-associated nausea and vomiting (CANV) in pediatric oncology patients. European Journal of Oncology Nursing, 19, 182–190.
To determine the feasibility of using a combination of relaxation techniques and patient education (multidimensional psychoeducational intervention package) to alleviate (chemotherapy-induced nausea and vomiting (CINV) while estimating the effect size and assessing the research design feasibility and stability of the Morrow Assessment of Nausea and Emesis (MANE) and the Chinese version of the State-Trait Anxiety Inventory (STAI) in children
Two intervention groups and two matching control groups were followed for 60 days. Patients randomly were assigned to the relaxation (progressive muscle relaxation [PMR] and guided imagery [GI]) or the education group. Patients in the relaxation group received six sessions of daily PMR and GI training (days 0–5, 30 minutes per session) and daily self-practice for two months with a PMR and GI audiotape. Patients in the education group received two 30-minute sessions of patient and parent education on days 1 and 2 (risk assessment, antiemetic use, and meal planning). The usual care also was given to participating patients, which included antiemetic ondansetron intravenously as needed and diet advice (i.e., avoid spicy and greasy food, eat easily swallowed and digested food).
Exploratory pre- and post-test control group pilot study
Because of the small sample size, the findings were not confirmatory. A significant reduction in vomiting as a possible result of the relaxation exercise was reported on day 3 (the day most patients in the study experienced CINV and a lowered performance status and satisfaction with care). From days 2–7, fewer patients in both intervention groups vomited compared with the control groups. Anticipatory nausea and vomiting was experienced by 40% of patients prior to chemotherapy. The study was feasible, but it took 18 months to recruit 20 patients. Patients and parents prefered relaxation to the education intervention. MANE and STAI scales were easy to understand in Chinese, and there were no difficulties with completion.
Relaxation and education could reduce vomiting. Anticipatory nausea and vomiting also may be alleviated with relaxation techniques. The early intake of antiemetics controlled and decreased patients' experience of CINV.
Relaxation and patient education (major components of a combined psychoeducational interventions) are potential helpful for CINV and are accepted techniques. However, preventive measures provided before the commencement of chemotherapy are more helpful. Patients preferred relaxation for anxiety reduction over education.
Chan, C.W., Cheng, K.K., Lam, L.W., Li, C.K., Chik, K.W., & Cheung, J.S. (2008). Psycho-educational intervention for chemotherapy-associated nausea and vomiting in paediatric oncology patients: A pilot study. Hong Kong Medical Journal, 14(5 Suppl.), 32–35. Retrieved from http://www.hkmj.org/article_pdfs/hkm0810sp5p32.pdf
To assess the feasibility of using relaxation and patient education
Patients were placed in group 1 or 2 (no randomization information). Group 1 received training of progressive muscle relaxation (PMR) and guided imagery (GI) with audiotapes daily on days 0–5, then practiced daily for two months. Group 2 received two 30-minute patient/parent education sessions on day 0 and day 2 focusing on risk assessment, antiemetic use, and meal planning. All subjects completed instruments at baseline (prior to chemotherapy), then daily for seven more days. At one and two months after the intervention, anxiety, compliance with PMR and GI (group 1 only), satisfaction with care, and quality of life were assessed. Pulse and blood pressure were reported in the findings but not listed in the procedure.
At baseline, group 1 had significantly lower anxiety than group 2 (p = 0.032). Group 1 had less vomiting on day 3 compared to the control group (p = 0.036). No significant differences of antiemetic use existed between the intervention and control groups. No significant differences existed in body weight, chemotherapy-induced nausea and vomiting (CINV), antiemetic use, quality of life, and caloric intake between groups. The health diaries indicated that the patients practiced PMR 3–4 times weekly at home with no significant changes in blood pressure or pulse. Patient and parents reported that the interventions were moderately useful.
This study is poorly designed, and the findings should be used cautiously. The authors reported that PMR and education can reduce CINV; however, no conclusions should be made except that further research is warranted.
The study is of too poor a quality to provide any implications for nurses. Well-designed research in this area is needed.
Chan, C.W., Richardson, A., & Richardson, J. (2011). Managing symptoms in patients with advanced lung cancer during radiotherapy: Results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management, 41, 347–357.
To examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue compared with usual care
A 40-minute educational intervention consisted of preparatory information; discussion of symptom experience; exploration of means of, and goals associated with, symptoms; advice on self-care strategies; and training and practice in progressive muscle relaxation. The educational package consisted of an audiotape and leaflets as well as discussion on the selected symptoms and their self-care management.
Patients were undergoing the active treatment phase of care.
A pre/post-test randomized controlled trial design was used.
Univariate tests on anxiety showed a significant difference (p = 0.001) in the pattern of change over the course of time, with a very small effect size (partial eta² = 0.051).
Findings suggest that interventions such as those tested in the current study, including progressive muscle relaxation, education, and counseling, have significant effects on patterns of symptom change over time.
Progressive muscle relaxation and education may be helpful in managing anxiety, fatigue, and breathlessness in patients with cancer, but effects may be small.
Chan, R.J., Webster, J., & Marquart, L. (2011). Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews, 12, CD008273.
To assess effects of interventions that orient patients and carers to a cancer care facility and to the services provided
Initial searching identified 14,319 records. Investigators assessed 21 full-text articles for eligibility, and the systemaic review included a sample of four. Two studies were included in meta-analysis. Study quality was assessed using guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.
Effects of Interventions
This review shows that orientation programs may reduce distress in patients with cancer at the beginning of their involvement with a cancer care facility, but the quality of the evidence is low. Orientation programs may have some effect on general distress and symptoms of depression; however, findings do not show significant effects on anxiety.
These findings are limited by the small number of trials included, low quality of studies, and high heterogeneity found related to some outcomes.
Orientation of the patient, the patient's family, and those who care for the patient may help to reduce a patient's symptoms of depression and level of distress; however, this study does not reveal strong support for these outcomes. The most effective format and timing of orientation approaches are unclear.
Chambers, S.T., Sanders, J., Patton, W.N., Ganly, P., Birch, M., Crump, J.A., & Spearing, R.L. (2005). Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: Results from a prospective randomized controlled trial. Journal of Hospital Infection, 61, 53–61.
The purpose of the study was to evaluate the efficacy of sustained-release chlorhexidine (CHX) dressings versus standard dressings.
All adult patients admitted under the hematology service that were to receive chemotherapy and had a tunneled cuffed central intravascular catheter inserted were eligible for inclusion. After insertion, all tunneled intravascular catheters were randomized, but they were treated in the same manner with a sterile gauze and porous adhesive dressings until the exit site was dry and free from ooze. Those randomized to standard catheter exit-site treatment (control group) received no dressing in accordance with BCHS guidelines. The CHX group (intervention group) were treated with CHX dressings consisting of a 2.5 cm hydrophilic polyurethane foam disk containing CHX gluconate in a sustained-release formulation. These were applied to the exit site as soon the oozing had stopped following intravascular catheter insertion, and changed as needed or weekly until the catheter was removed. The same treatment was continued for the life of the catheter but if an intravascular catheter was removed and replaced, the new catheter was randomized. Exit site and tunnels were routinely examined on a weekly basis.
The primary endpoint of this study was the development of exit-site and/or tunnel infection. The secondary endpoint was removal of the catheter for infection. In total, 114 tunneled intravascular catheters in 95 patients were randomized from August 1998 to December 2001.
A single-site inpatient hematology unit
Prospective, randomized
All patients received a 10F vascular catheter with a surecuff tissue ingrowth, vitacuff antimicrobial cuff inserted percutaneously by a radiologist using the Seldinger technique.
Definitions used:
This study has shown that the use of CHX dressings was associated with less exit site infections (OR = 0.13, 95% CI [0.04, 0.37], p < 0.001). The rate of premature catheter removal for these infections was reduced approximately three fold in the CHX group (OR = 0.23, 95% CI [0.07, 0.77]). The failures of the CHX dressing group were associated either with a very early occurrence after insertion of the catheter, suggesting that the infecting organisms were implanted at the time of catheter insertion, or with delays in application of the CHX dressing. Positive blood cultures occurred in fewer patients in the control group (p < 0.01) with less isolates of gram-positive organisms in the control group (p < 0.05).
This study demonstrated that use of the sustained-release CHX dressing was associated with reduced extralumenal catheter infections; however, it was not associated with fewer blood stream infections.
Sustained-release CHX dressings may help to reduce some central line-associated infections in patients with cancer who are at risk and in whom other aspects of catheter insertion and care are in place. Further well-designed research in this area is warranted.
Chambers, S.K., Pinnock, C., Lepore, S.J., Hughes, S., & O'Connell, D.L. (2011). A systematic review of psychosocial interventions for men with prostate cancer and their partners. Patient Education and Counseling, 85, e75–e88.
To update a prior systematic review and address the following two clinical questions: (1) Do psychological and cognitive interventions improve psychological adjustment in men with prostate cancer? and (2) Do such interventions alleviate partner distress and improve quality of life in those men?
A total of 195 references were retrieved.
Following a literature search of chosen databases, two reviewers independently reviewed studies identified as relevant to the two study questions. Reviewers used previously published PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and national (Australian) research criteria to assess studies for inclusion in the systematic review. Study quality was poor, with few studies using double blinding, adequate concealment of treatment allocation, intention-to-treat analysis, and incorporating statements on allocation sequences for study participants. A higher proportion of studies completed after 2005 had sufficient concealment of allocation sequence than those completed before 2005. However, later studies had exclusions that were more likely to cause bias than earlier studies. Some of the 21 studies used in the systematic review did not include useful data to evaluate the intervention, did not collect baseline data, nor provide evidence of significant differences between intervention and usual care groups.
Transition phase after active treatment
Fourteen studies provided relevant information to answer the patient question (1). These studies indicated that group cognitive behavioral programs, with focus on stress management and long-term, nurse-led education and support, positively influenced improved quality of life for patients with prostate cancer. Men with localized disease experienced physical quality-of-life benefits (but not mental quality-of-life, mood, or cancer worry benefits) when exposed to stress management and education at the time of surgery. Four studies provided useful information to answer the caregiver/partner question (2): patient/caregiver dyads exposed to a psychoeducation intervention with a focus on coping skills reported improved quality of life. Nonsignificant or inconsistent results on intervention effects on patient uncertainty, hopelessness, and depression were found across studies. One study improved caregiver physical quality of life, uncertainty, and symptom distress in the short term, but patients did not experience significant benefits from the intervention.
Group cognitive behavioral interventions focused on stress management, led by an expert in psychology, and nurse-led psycho-educational interventions seem to support better psychological adjustment and quality of life of patients with prostate cancer with localized disease. Coping skills interventions appear to help patient/partner adjustment, although evidence remains limited to guide oncology practice. Limitations in studies used for this systematic review include limited samples of diverse individuals, those with advanced disease, and gay men needed to guide effective and equitable interventions and healthcare policy. Although common in North America and Australia, more peer-led interventions, particularly with late-stage survivors of prostate cancer, need to exist based on evidence of their success in decreasing patient isolation and providing information and emotional support. Additional studies must be conducted to validate effective ways, including healthcare structural and process change, to meet the emotional and quality-of-life needs of survivors of prostate cancer at various phases of the disease process and their caregivers.
Continued nursing research to identify successful and cost-effective programs to improve the quality of life of patients with prostate cancer and their partners must occur. This systematic review found inconsistent findings that advocate for rigorous studies that can offer guidelines for effective family-based and home programs using a variety of formats at various phases of prostate cancer.
Chambers, S.K., Girgis, A., Occhipinti, S., Hutchison, S., Turner, J., McDowell, M., . . . Dunn, J. C. (2014). A randomized trial comparing two low-intensity psychological interventions for distressed patients with cancer and their caregivers. Oncology Nursing Forum, 41(4), E256–E266.
To compare the effectiveness of nurse- and psychologist-delivered psychoeducational interventions for distressed patients and caregivers who had called a cancer helpline seeking support
Individuals who called the helpline were randomized to a five-session psychologist intervention using a cognitive behavioral approach or a single nurse-delivered session for education and support for self-management. All sessions were provided by telephone. Those in the single-session group were mailed a self-management resource kit, including written advice about stress management, problem solving, healthy lifestyle, and mobilizing support networks, along with an audio CD about relaxation exercises. All participants completed a baseline distress thermometer, and those who had a score of 7 or greater also received a follow-up phone call after the nurse session three weeks later. Study measures were obtained at baseline and at 3, 6, and 12 months. Caregivers and patients were not dyads because helpline calls were done individually.
Of the patients and caregivers, 93% completed the single-session intervention and 53% completed all five psychologist interventions. In the nurse arm, the mean intervention duration was 46.51 minutes, and the psychologist mean session duration was 46.43 minutes. Distress-related outcomes decreased over time, and positive adjustment increased over time in both groups. Effects size over 12 months was 0.19 in the nurse intervention group and 0.2 in the psychologist group. Cancer-specific distress decreased significantly over time for caregivers (p < .001), and positive adjustment increased (p < .001) with no significant difference between groups. Thirty-five percent of those in the nurse group received a follow-up phone call because of their distress score, and 3% were referred for additional support services.
Both the brief nurse contact for psychoeducation and self-management support and the telephonic CBT approach interventions provided by a psychologist were associated with reduction in distress and improvement in positive adjustment among caregivers of patients with cancer who had contacted a cancer helpline.
Findings suggest that caregivers, as well as patients, can benefit from a single-session nursing psychoeducational session provided by telephone and supported by self-management resource materials. Findings also showed that five telephonic sessions provided by a psychologist with a CBT approach also were helpful. Specifically, cancer-related distress can be approached effectively with a short, practical telephonic intervention for patients who identified a need for support by calling a helpline. Although this study has some design limitations in terms of sampling frame, it is very applicable for a real-world situation.
Chamberlain, B.H., Cross, K., Winston, J.L., Thomas, J., Wang, W., Su, C., & Israel, R.J. (2009). Methylnaltrexone treatment of opioid-induced constipation in patients with advanced illness. Journal of Pain and Symptom Management, 38, 683-690.
To describe laxative response to subcutaneous methylnaltrexone in patients with advanced illness and opioid-induced constipation.
Patients were randomly assigned to receive either methylnaltrexone 0.15 mg/kg or placebo subcutaneously every other day for two weeks. Patients were permitted to continue their baseline laxatives. By day 8, the study drug dose (methylnaltrexone or placebo) could be doubled if patients had fewer than three rescue-free bowel movements (BMs).
The study has clinical applicability for the end-of-life and palliative phases of care.
This was a post-hoc analysis of a two-week double-blind, randomized, placebo-controlled study.
Methylnaltrexone 0.15 mg/kg administered subcutaneously every other day was effective in relieving opioid-induced constipation.
Sixteen percent of patients (10 of 62) in the methylnaltrexone group and 24% (17 of 71) in the placebo group did not complete the study.
Subcutaneous methylnaltrexone 0.15 mg/kg appears to be effective in relieving opioid-induced constipation in a timely and predictable manner without reducing pain control or producing symptoms of opioid withdrawal. If an individual does not respond to the first dose, they may still receive some benefit with additional doses. However, the response rate decreased to 25% for individuals receiving a third dose in this study. Reasons for constipation other than opioid use may need to be looked for in nonresponders.
Challapalli, V., Tremont-Lukats, I.W., McNicol, E.D., Lau, J., & Carr, D.B. (2005). Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database of Systematic Reviews, 19(4).
STUDY PURPOSE: To assess lidocaine given in different doses in comparison with a placebo, diphenhydramine as a placebo, and active controls (morphine sulfate, ketamine, or amantadine). Mexiletine was compared to an inactive placebo and an active placebo (amitriptyline and gabapentin). Tocainide was used in one trial against carbamazepine. Pain was rated on an 11-point numeric rating scale (NRS).
DATABASES USED: MEDLINE 1996–2004; EMBASE 1980–2002; CancerLit through December 2002; Cochrane Central Register of Controlled Trials through the second quarter of 2004; System for Information on Grey literature in Europe (SIGLE) and LILACS 1996–2001; hand searches of conference proceedings, textbooks, original articles, and reviews
Intravenous lidocaine and its oral analog mexiletine were more effective than a placebo in decreasing neuropathic pain, were safe, and were as effective as other analgesics. The treatment effect was similar for both drugs. The analgesic effect was clinically important.
More than one half of the 29 trials were of low or fair methodological quality. One third did not adequately describe the method for random allocation, and 80% did not estimate the number of participants needed to have statistical power. However, some of these deficiencies could be because of incomplete reporting. Five trials did not describe exclusion criteria.
There is a need to study specific diseases and patient satisfaction to assess if statistically significant pain relief is clinically meaningful.
Chakrabarty, J., Vidyasagar, M., Fernandes, D., Joisa, G., Varghese, P., & Mayya, S. (2015). Effectiveness of pranayama on cancer-related fatigue in breast cancer patients undergoing radiation therapy: A randomized controlled trial. International Journal of Yoga, 8, 47–53.
To determine the effectiveness of pranayama yoga on fatigue during radiation therapy
Patients were randomized to receive only radiation therapy with routine care or to perform pranayama during radiation therapy. Those in the yoga group performed pranayama morning and evening five days per week for six weeks under supervision. Fatigue was assessed at the beginning and end of radiation therapy.
PHASE OF CARE: Active antitumor treatment
Randomized, controlled trial
Cancer fatigue scale
Post-test fatigue scores in the intervention group were lower (p = 0.001), and the intervention group had a significant decline in fatigue score (p = 0.001); however, all scores continued to be in the range of mild fatigue only.
Pranayama may be helpful to prevent or reduce fatigue during treatment with radiation therapy.
Participation in yoga during cancer treatment may be helpful to combat symptoms of fatigue. This is a low-risk intervention that nurses can suggest to patients to manage fatigue.