Zweers, D., de Graaf, E., & Teunissen, S.C. (2015). Non-pharmacological nurse-led interventions to manage anxiety in patients with advanced cancer: A systematic literature review. International Journal of Nursing Studies, 56, 102–113.
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Palliative care
Four of seven interventions were educational. In some studies, education was combined with telemonitoring or progressive muscle relaxation. Counseling and coaching as self-care strategies for monitoring symptoms were evident in two studies. Two studies focused on expressive writing, and focused narrative interview. One study compared aromatherapy with massage. Interventions were performed by nurses and research nurses, with or without training. Duration of interventions ranged from 1-3 contacts in one week to six months. Contacts were face-to-face or by telephone. None of the studies documented patient adherence to the interventions. The development of the interventions was limited to literature review. Two studies showed significant differences between the intervention and control group at six months (telemonitoring combined with education). One study did not show significance between the control and intervention groups at one week. A study of progressive muscle relaxation showed significance in anxiety at week 6 and week 12. No significant effect on anxiety was found between aromatherapy and massage. There was significantly decreased anxiety after each massage. This was also seen in a study that focused on narrative interview.
Although some of the studies described showed some significance, all had limitations. Studies are scarce; only seven met the inclusion criteria.
Some studies had a high attrition rate. The authors defined several areas of bias including selection, performance, attrition, and reporting. There was limited information regarding development of interventions. There was not enough information on any one intervention to be able to clearly to implement it as evidence.
Evidence regarding nonpharmacologic nursing interventions for anxiety is scarce. More nursing research is indicated, including well-developed interventions.
Zumberg, M.S., del Rosario, M.L., Nejame, C.F., Pollock, B.H., Garzarella, L., Kao, K.J., . . . Wingard, J.R. (2002). A prospective randomized trial of prophylactic platelet transfusion and bleeding incidence in hematopoietic stem cell transplant recipients: 10,000/L versus 20,000/microL trigger. Biology of Blood and Marrow Transplantation, 8(10), 569–576.
To determine the prophylactic platelet transfusion threshold (10,000/L versus 20,000/microL) in bone marrow transplant (BMT) patients, comparing transfusion requirements, incidence of bleeding, and adverse events
Patients undergoing BMTs that matched study requirements were randomized into two groups. One group would receive a prophylactic platelet transfusion if their morning platelet count was below 20,000/micro/L, and the other group would receive a transfusion at less than 10,000/L. For the 10,000/L group whose morning count was between 10–15,000/L, platelet count was checked a second time 12 hours later, and patients received a transfusion if this count fell below 10,000/L. A postplatelet count was taken 30–90 minutes post transfusion, and another bag was given if the threshold was not met with the first transfusion. If patients had scheduled procedures, acute bleeding events, or other safety concerns, platelets were transfused as needed. The threshold level was resumed following the acute event. Red blood cells were transfused as needed for hematocrit levels below 20%. Leukocyte-reduced, irradiated platelets were used for the study; they were single-donor, ABO matched when available. A transfusion algorithm was developed for both groups so that it was clear for the care team when to transfuse, redraw labs, and/or perform calculations.
Randomized, controlled trial, unblinded for patient safety
Bleeding events were scored by a single-study nurse using a modified Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) Bleeding Severity Grading Scale.
There was no significant difference in bleeding events between the two groups with similar causes of bleeding in both (mucocutaneous and genitourinary). None of the patient deaths in the study were attributed to bleeding, although CNS bleeds occurred in both groups. The mean number of bleeding days were similar for the two groups. Bleeding was more frequent for the allogeneic or matched unrelated donor groups, but the results were not statistically significant. The time to first transfusion was 3.7 days in the 10,000/L group versus 4.2 days in the 20,000/microL group (p = 0.91). The total number of transfusions was similar in both groups. Amphotericin B, GVHD, transplant type, and VOD were statistically significant predictors of bleeding, while the threshold transfusion level was not.
The findings of this study mirrored prior research of this kind that was done for other populations, finding that the lower, 10,000/L platelet count can be used safely as a threshold for transfusions for the BMT population as well. There were no significant differences among the two groups with respect to bleeding risks and/or safety to patients. Of note, amphotericin B use did lead to a significantly increased risk of bleeding to patients, and so those patients may need a higher platelet threshold although that level was not studied in this trial.
Nurses need to look at the policy and procedures for platelet transfusions at their own institutions and suggest changes in practice if patients are given platelets for values above 10,000/L unless otherwise contraindicated. This study implies that this threshold is as safe as a higher one, and it leads to fewer transfusions for patients, which can reduce risk of transfusion reactions and platelet refractoriness without increasing bleeding risk.
Zucchella, C., Capone, A., Codella, V., De Nunzio, A.M., Vecchione, C., Sandrini, G., . . . Bartolo, M. (2013). Cognitive rehabilitation for early post-surgery inpatients affected by primary brain tumor: A randomized, controlled trial. Journal of Neuro-Oncology, 114, 93-100.
To evaluate the effectiveness of a cognitive rehabilitation program within two weeks of surgical resection for patients with primary brain tumors
Baseline neuropsychological assessments were performed within three days of admission to the inpatient rehabilitation unit and prior to treatment or control randomization. Treatment arm consisted of 16 one-hour individual sessions over a four week timeframe with content focused on time orientation, spatial orientation, visual attention, logical reasoning, memory recognition, and executive functions. Each session was therapist-guided with 45 minutes of computer-based exercises and 15 minutes of discussion about the exercises and how to apply the strategies to everyday life. In both arms of the study, patients received usual rehabilitation care with medication and physical therapies.
PHASE OF CARE: Active antitumor treatment
Randomized double-blind control trial with pre- and post-test assessments at baseline and four weeks after randomization
Within-group analyses found significant improvements (p < 0.05) on all neuropsychological tests for the treatment arm, while the control arm showed a non-significant trend towards improvement. Significant differences between groups were observed for improvements in visual attention and verbal memory (RAVLT-DR, Logical memory-IR and DR, TMT-A, TMT-B, Attentive matrices). There was no difference between groups in the socio-demographic, clinical characteristics, or baseline neuropsychological test scores. There was no difference between groups for number of subjects withdrawing from study due to medical conditions.
This inpatient cognitive rehabilitation program was developed for patients with a post-surgical primary brain tumor. Those receiving the intervention showed significant cognitive improvement in all domains, yet only visual attention and verbal memory performances were significantly different when compared to usual rehabilitation care. These results are limited by sample size, lack of additional longitudinal assessments to demonstrate sustained improvement, and program cost.
Post-surgical cognitive interventions may be helpful in developing cognitive strategies for everyday function. Further study is warranted and intervention adaptation is necessary for outpatient settings.
Zou, L.Y., Yang, L., He, X.L., Sun, M., & Xu, J.J. (2014). Effects of aerobic exercise on cancer-related fatigue in breast cancer patients receiving chemotherapy: A meta-analysis. Tumour Biology, 35, 5659–5667.
PHASE OF CARE: Active
The Revised Piper Fatigue Scale (RPFS) scores for patients with breast cancer were significantly lower in the intervention group than the control group. However, there was no significant difference in the Functional Assessment of Chronic Illness Treatment Fatigue (FACIT-F) scale scores between the intervention and control groups. A subgroup analysis by ethnicity indicated that there were significant differences in RPFS and FACIT-F scores between the intervention and control groups among Asian populations.
This study provided additional support for aerobic exercise as an intervention for CRF in women receiving chemotherapy for breast cancer, especially Asian women. However, it did not help determine the frequency, intensity, or duration of aerobic exercise that is most beneficial for CRF.
Nurses can continue to recommend aerobic exercise for women receiving chemotherapy for breast cancer. However, additional research is needed regarding the frequency, intensity, and duration of exercise.
Zou, J.Y., Xu, Y., Wang, X.H., Jiang, Q., & Zhu, X.M. (2015). Improvement of constipation in leukemia patients undergoing chemotherapy using sweet potato. Cancer Nursing, 39, 181–186.
To determine whether sweet potatoes can alleviate constipation in patients with leukemia undergoing chemotherapy
Patients with leukemia, while receiving the first cycle of chemotherapy, were randomized to an intervention group (n = 57) or control group (n = 63). Both the groups were given routine care that included psychological intervention, abdominal massage, increased water intake (> 3000 ml per day), appropriate physical activities for condition of the patient during chemotherapy, and dietary modification (combination of course and refined grains plus fruit intake). If patients demonstrated symptoms of constipation, then laxatives or enemas were administered. The intervention group received routine care plus a diet containing sweet potato. The intervention started the day of admission and ended the day of discharge.
On the second day after starting the chemotherapy, the rate of constipation was significantly lower in the intervention group compared with the control group (p < 0.001). All the items in the FGIDs criteria for evaluating constipation except for “almost no loose stools without purgative use” were significantly improved in the intervention group (p < 0.01), and the number of patients with first defecation within 24 hours after chemotherapy was significantly higher in the intervention group than in the control group (p < 0.001). The duration of defecation was significantly shortened in the intervention group after chemotherapy (p < 0.001), but the satisfaction was similar in both groups. On the fifth day, the rate of constipation was significantly lower in the intervention group, and results were similar as day two. All the items in the FGIDs criteria for constipation except for “sensation of anorectal obstruction” and “manual assistance” were significantly improved in the intervention group.
This study demonstrated that sweet potatoes have a positive impact on prevention of constipation and defecation satisfaction in patients receiving chemotherapy for leukemia.
Sweet potatoes are an inexpensive vegetable that can be easily and assessable to patients undergoing treatment for leukemia in prevention of chemotherapy-induced constipation.
Zimmer, P., Baumann, F.T., Oberste, M., Wright, P., Garthe, A., Schenk, A., . . . Wolf, F. (2016). Effects of exercise interventions and physical activity behavior on cancer related cognitive impairments: A systematic review. BioMed Research International, 2016, 1820954.
STUDY PURPOSE: To evaluate the effectiveness of an exercise intervention and physical activity behavior on cancer-related cognitive impairment
TYPE OF STUDY: Systematic review
PHASE OF CARE: Late effects and survivorship
In patients, studies of exercise interventions had mixed results regarding their effectiveness in improving cognitive function. Interventions reviewed included an undefined physical activity (n = 3), cardiovascular fitness (n = 1), home-based walking and resistance band training (n = 1), yoga (n = 3), speed-feedback therapy on a bicycle ergometer (n = 1), medical qigong (n = 1), physical activity behavior change program (n = 1), Tai chi (n = 1), progressive aerobic endurance training on a treadmill (n = 1), and strength training (n = 1). Although the review reported cross-sectional studies that revealed correlations between physical activity with visual memory (n = 1), executive function (n = 1), attention (n = 1), and information processing (n = 1), the strength of these correlations was not reported. Randomized, controlled trial studies reported improved perceived cognitive functioning with walking, yoga, and medical qigong but not with the physical activity behavior change program. In addition, improvements were found for executive function with speed-feedback therapy, attention and verbal memory (but not working memory with strength training), and memory with yoga. However, in each of these results, the significance of these findings was not reported. These results are further complicated by the lack of consistency in regard to the cognitive functioning measures used.
Exercise may improve perceived cognitive function. However, further research is needed to validate if specific types of exercise affect cognitive functioning and to determine the dose or duration required for a durable response. Longitudinal studies with larger sample sizes that incorporate both objective and subjective measures of evaluating cognitive function are needed before recommendations for exercise can be made as a means to counteract chemotherapy-related cognitive impairment.
The findings suggest that some forms of exercise or physical activity interventions may be helpful in improving patients’ perception of chemotherapy-induced cognitive impairment; however, these findings are based on a small number of studies per intervention. Recommendations cannot be made based on this review.